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									   STUDENT CLINICIAN HANDBOOK



BASTYR CENTER FOR NATURAL HEALTH


            TEAM CARE



             2002-2003
Table of Contents
BCNH ADMINISTRATION AND STAFF                                      5
WELCOME/VISION & MISSION OF BASTYR UNIVERSITY                      9
PURPOSE OF THE HANDBOOK                                            10
ACUPUNCTURE AND ORIENTAL MEDICINE DEPARTMENT OVERVIEW              11
NATUROPATHIC MEDICINE OVERVIEW                                     12
PROGRAMS OF STUDY                                                  13
ND CLINICAL FACULTY /NUTRITION CLINICAL FACULTY                    14
CLINIC EDUCATION REQUIREMENTS                                      15
CLINIC ENTRY COURSES                                               16
ND CLINIC ENTRY I                                                  17
ND CLINIC ENTRY II                                                 19
ND PREREQUISITES TO ENTER CLINIC                                   20
NUTRITION CLINIC ENTRY                                             21
AOM SUMMARY OF CLINIC REQUIREMENTS                                 22
SUMMARY OF ND CLINIC REQUIREMENTS                                  26
ND PATIENT CARE (PC) SHIFTS AND CLINICAL LAB DIAGNOSIS ROTATIONS   28
ND COUNSELING SHIFT GUIDELINES                                     30
NUTRITION CLINIC REQUIREMENTS                                      32
INTERIM CLINIC                                                     34
AOM PRECEPTORSHIP PROGRAM                                          38
ND and AOM ADVANCED PRECEPTORSHIP                                  40
CLINIC OUTREACH GUIDELINES                                         42
AOM PROGRAM CHINA EXTERNSHIP                                       45
STUDENT ACADEMIC ADVISING: ND AND AOM                              46
STUDENT REGISTRATION FOR CLINIC SHIFTS                             47
INCLEMENT WEATHER POLICY                                           50
CLINIC ATTENDANCE POLICY                                           51
ABSENCE AND SUBSTITUTION                                           53
SUBSTITUTE/EXTRA HOURS                                             54
SANCTIONS                                                          55
LOSS OF CREDIT, SUSPENSION, DISMISSAL                              55
CLINIC GRIEVANCE POLICY FOR STUDENTS                               57
CLINIC GRIEVANCE POLICY for PATIENTS                               58
PERFORMANCE EVALUATIONS                                            58
GRADING                                                            60
COMPETENCIES                                                       94
CONFIDENTIALITY POLICY                                             95
PROFESSIONAL CONDUCT                                               97
CODE OF ETHICS: BASTYR CENTER FOR NATURAL HEALTH                   98
CLINIC GUIDELINES FOR DRESS, HYGIENE AND GENERAL APPEARANCE        100
IMMUNIZATION POLICY                                                102
CLINICAL PROCEDURES, POLICIES AND PROTOCOLS                        104
PATIENT VISIT PROCEDURE                                            105
AOM/ND/NUTRITION PRIMARY/INTERN STUDENT CLINICIAN                  106
AOM/ND/NUTRITION SECONDARY/OBSERVER STUDENT CLINICIAN              108
PATIENT RECORDS AND RELATED FORMS                                  111
PATIENT CHARTS                                                     112
CHARTING SOAP FORMAT                                               116
NEW SUPERBILL INSTRUCTIONS FOR FACULTY AND STUDENTS                120


                                 Page 2
INTERVIEW GUIDELINES                                                                    121
PHSICAL EXAM GUIDELINES                                                                 122
SHIFT GUIDELINES FOR ND PATIENT CARE and AOM OBSERVATION AND INTERN SHIFTS              122
AOM/ND/NUTRITION CASE PREVIEW PROTOCOL                                                  125
PATIENT MANAGEMENT POLICIES                                                             127
MEDICAL RECORDS                                                                         127
INSURANCE                                                                               129
PATIENT CARE CPT CODING WORKSHEET                                                       133
PATIENT SCHEDULING                                                                      137
AOM/ND/NUTRITION PATIENTS REFERRED TO CLINIC                                            137
AOM /ND/ NUTRITION PATIENT REFERRALS TO OUTSIDE PHYSICIANS/HEALTH CARE                  139
PROVIDERS
INTRACLINIC REFERRALS                                                                   139
CLINICAL LABORATORY                                                                     140
NATUROPATHIC TREATMENT OF MALIGNANCY                                                    145
INTERPRETER SERVICES POLICY                                                             147
AOM/ND/ NUTRITION TELEPHONE CONTACT                                                     149
HANDWASHING AND DISINFECTION                                                            149
ND AND AOM CLEAN NEEDLE TECHNIQUE AND BIOHAZARD WASTE HANDLING                          150
SENTINEL EVENTS                                                                         151
PROCEDURE: REPORTING A VISITOR/PATIENT ACCIDENT/ILLNESS EVENT                           153
COMMUNICABLE DISEASE OUTBREAK                                                           155

EARTHQUAKE RESPONSE PLAN                                                                156
MISCELLANEOUS                                                                           157
RESIDENCY                                                                               158
CLINICAL COMPETENCIES                                                                   159
UNIVERSITY GLOBAL COMPETENCIES                                                          160
Principles of Traditional Chinese Medicine                                              161
AOM CLINICAL TRAINING - LEARNING OBJECTIVES                                             164
Clinical Competency One - Observation I, II, and III                                    164
Clinical Competency Two - Internship I, II, III, IV and V                               165
Clinical Competency Three - Internship VI, VII, VIII                                    166
Clinical Competency Four - Internship IX, X, XI                                         167
Clinical Competency Five - Internship XII and XIII                                      168
Clinical Competency Six - Internship XIV                                                169
Clinical Competency Seven – Categories of Disease/Conditions for Therapeutic Plans      171
Clinical Competencies – Nutrition -                                                     172
Nutrition Department – SOAP Format                                                      178
Exit Examination For Graduating Clinical /Counseling Track Nutrition Students           180
PRINCIPLES OF NATUROPATHIC MEDICINE                                                     181
ND LEARNING OBJECTIVES FOR SECONDARY CLINICIANS                                         182
LEARNING OBJECTIVES FOR PRIMARY CLINCIANS                                               183
ND CLINICAL COMPETENCIES                                                                183
SECONDARY CLINICIANS                                                                    185
SECONDARY COMPETENCIES [Clinical Competency #2]                                         185
PRIMARY COMPETENCIES [Clinical Competency #1]                                           188
PRIMARY CLINICAL COMPETENCIES – CONDITIONS                                              194
CHECK-OFF OF PHYSICAL EXAMS TO BE PERFORMED BY CLINICIANS                               195
ND CLINICAL COMPETENCY THREE - Physical Medicine One (Secondary Clinician Objectives)   196
ND CLINICAL COMPETENCY THREE - Visceral Manipulation Clinic [Optimal Shift]             199


                                       Page 3
ND CLINICAL COMPETENCY FOUR - Physical Medicine Two (Primary Clinician Objectives)   200
HOMEOPATHIC MEDICINE DEPARTMENT                                                      202
COUNSELING DEPATMENT                                                                 205
ADDICTIONS AND DISORDERS                                                             206
PSYCHOLOGICAL ASSESSMENT                                                             207
DEATH AND DYING: COUNSELING THE TERMINALLY ILL AND THEIR FAMILIES                    207
SECOND COUNSELING SHIFT                                                              207
SECOND COUNSELING SHIFT IN THE IMMUNE CLINIC                                         207
ND CLINICAL COMPETENCIES - Clinical Competency Seven                                 208
PRODUCT ANALYSIS SHEETS                                                              210
APPENDICES:                                                                          214
MEDICAL ABBREVIATIONS                                                                237
DOCUMENTATION GUIDELINES FOR EVALUATION AND MANAGEMENT SERVICES                      244
CO-MANAGEMENT: TEMPLATES AND ETIQUETTE GUIDELINES                                    254
NATUROPATHIC TREATMENT OF MALIGNANCY CONSENT FORM                                    260




                                       Page 4
Center Organization Chart
                                                                   Phone extension
Bastyr Center For Natural Health                                        206-834-4100
Second Floor Appt. Desk
        5101
        2nd Floor Appt. Desk external line-in
        4101
Third Floor Appt. Desk
        5102
        3rd Floor Appt. Desk external line-in
        4102
Practitioner Care Desk
        4190
ND Resident Pager (urgent calls from patients only)                     206-200-7067
Dispensary
        4114
Hep C Hallway
        4111
Laboratory
        4113
Marketing
        4117
Medical Questions Line—internal voicemail access only
        5999
Medical Records
        4151
Dean of Clinical Affairs—Jane Guiltinan
        4105
                Executive Asst. to Dean of Clinical Affairs—Lynne McCutchen
        4178
        Medical Director—Lise Alschuler
        4159
                Administrative Coordinator—Alyse Aiello
        4119
                Clinic Program Coordinator—Lillian Rea
        4106
                Product Review Coordinator—Paul Dompe
        4156
                ND Clinical Department Coordinator—John Hibbs
        4158
                              ND Clinical Faculty
                              Karim Abdullah, ND-core faculty
        4127
                              Michelle Antonich, ND
                       5117


                                      Page 5
              Kevin Conroy, ND-core faculty
4134
              Jill Fresonke, ND
4161
              Keith Grieneeks, PhD-core faculty
4155
              Mark Groven, ND-core faculty                  4112
              Mary Ann Ivons, ND
5203
              Eric Jones, ND-core faculty
4129
              J. Little, ND
5201
              Richard Mann, ND-core faculty
       4135
              Melissa McClintock, ND-core faculty
4184
              Nancy Mercer, ND
5204
              Jana Nalbandian, ND-core faculty
4170
              Lauren Oktay, ND
4133
              Andrew Parkinson, ND-core faculty
4123
              Brian Peters, ND
5206
              Hazel Philp, ND, LAc-core faculty
4154
              Dirk Powell, ND
5530
              Bill Roedel, PhD-core faculty
5127
              Marian Small, ND
5208
              Jamey Wallace, ND-core faculty
4141

              ND Residents
              Steve Milkis, ND-2nd year
4148
              Amy Turnbull-Hueffed, ND-2nd year
4149
              Kevin Connor, ND-1st year              206-925-4661
              Heather Greenlee, ND-research fellow           5104
              Annie Hanaway, ND-1st year             206-925-4660

                         Page 6
                          Pamela Hannaman-Pittman, ND-1st year
      4128
                          Maide Romero, ND, LAc-1st year          206-925-4662
                          Sean Sapunar, ND-1st year
      4153
                          Michael Slezak, ND-1st year
      4171
                          Wendy Weber, ND-research fellow
     5105
AOM Clinical Department Coordinator—Steve Given
     4179
                          AOM Clinical Faculty
                          Benjamin Apirakchai, LAc
     5704
                          Qiang Cao, LAc-core faculty
     4197
                          Terry Courtney, LAc, Department Chair
     4162
                          Wei Yi Ding, LAc-core faculty                  5535
                          James Dowling, LAc
     5826
                          Matthew Ferguson, LAc
     4121
                          Susan Heideke, LAc
     5393
                          Kayo King, LAc
     5741
                          Chongyun Liu, LAc-core faculty
     4196
                          Tong Lu, LAc
     5703
                          Yuan Ming Lu, LAc
     5567
                          Andy McIntyre, LAc-core faculty
     4125
                          Hazel Philp, ND, LAc-core faculty
     4154
                          Janna Rome, LAc
     5705
                          Yajuan Wang, LAc-core faculty
     5561
                          Ying Wang, LAc-core faculty
     4122
                          AOM Residents
                          Kyo Mitchell, LAc-2nd year
     4176

                                    Page 7
                             Angela Tseng, LAc-2nd year
       4175
                             Chris Reilly, LAc-1st year
        4187
Nutrition Clinical Department Coordinator—Jim Gallagher
        4188
                               Nutrition Clinical Faculty
                               Anne Fittante, RD
        5126
                               Beverly Kindblade, RD-core faculty
        5112
Dir. Office of Grad. and Community Medicine—Gary Garcia, MD
        4124
        Placement/Preceptor Coordinator—Jeanne Kinley Deller
        4103
        Site Coordinator—Ione Turner
        4104
Clinic Administrator—Lisa Hopkins
        4118
        Lab Manager—Joseph Syersak
        4137
                Clinical Lab Supervisor—Tracy Meyer
        5402
        Clinic Receptionist—Ann Thurman Burnell
        5500
        Patient Services Manager—Martin Imbach
        4108
                Asst. Patient Services Mgr.—Amanda McIllece
        4173
                               Medical Office Assistants
                               Scott Holland
5304
                               Harriet Ann Majors
5301
                               Chelsea Rask
5223
                               Zandi Salstrom
5312
                               Kathryn Tilson
5432
                               David VanHollebeke
5400
                               Shawna Hartnett
5108
                               Zoe DePaz
5132

                                        Page 8
                           Britta Petrelli
5131
                    Practitioner Care Asst. —Joseph Yurgevich
5515
             Medical Records Coordinator—Anthony Amos
4151
                    File Clerk—Jennifer Barrett
5314
                    Medical Records Asst.—Katie Hunt
5309
       Dispensary Manager—Ann Busch
4145
                           Dispensary Supervisors
                           Barbara Nims
5848
                           Kelly Uusitalo
4109
                           Lead Disp. Assts.
                           Kathleen Jancoski
5110
                           Gillian Mamacos
5767
                                   Dispensary Assistants
                                   Donna Grisham
5516
                                   Michelle Seligman
5513
                                   Brandi Solace
5116
                                   Andi Matack
5125
       Chinese Herbal Med. Dispensary Manager—Matt Ferguson
4121
                           CHM Dispensary Assts.
                           Alan Sayigh
5791
                           Mercy Yule
5601
       Operations Manager—Jennifer Mulford
4130
             Asst. Operations Manager—Steevie Bereiter
4157
             Asst. Operations Manager—Michael Hernandez
4110
                           Clinic Assts.


                                       Page 9
                           Roger Easterbrooks
4185
                           Joseph Chodykin
5128
       Billing and Patient Accounts Manager—Deana Ganter
4164
             Accts. Receivable Asst.—Lisa Brisbois
4186
             Patient Acct. Specialist—Meredith Cypress
4152
             Asst. Mgr./Referral Coordinator—Kat Terran
4126
             Credentialing Coordinator—Jane Wheeler
4177
             Business Dept. Helpline
4183
       Accounting and Budget Manager—Christine Shields
4150

       Research Dept
              Director—Leanna Standish
4111
             Hep C Clinic Mgr.—Deana Rich
4111
             Project Mgr.—Wendy Weber
4139
             Research Asst.—Shawn Goodwin
4139
             Project Coordinator—Jeanna Goesling
4139
             Research Asst.—Langley Partridge
4139
       Marketing Director—Laura Biggers
4117




                                       Page 10
WELCOME…

Welcome to the Bastyr Center for Natural Health! You are about to embark on a very
exciting and wonderful part of your training at Bastyr University. The Bastyr Center for
Natural Health is expected to provide more than 30,000 patient visits this year. The services
of each program and the integration between programs offer some of the best natural
medicine care anywhere! The Staff and Faculty of the Center for Natural Health are excited
about your entry into the clinical portion of your training and look forward to your unique and
important contributions.

The mission of the Bastyr Center for Natural Health is to create an extraordinary
environment committed to excellence in health care and clinical education that assists and
empowers individuals and the community to achieve better health and a higher quality of life.


The Vision of Bastyr University
Bastyr University will be the world’s leading academic center for advancing knowledge
in the natural health sciences.


The Mission of Bastyr University
We educate future leaders in the natural health sciences that integrate mind, body, spirit
and nature. Through natural health education, research and clinical services, we improve
the health and well being of the human community.




                                          Page 11
PURPOSE OF THE HANDBOOK
The purpose of the Student Clinician Handbook is to outline the policies, standards, and
guidelines for you to function effectively during your clinical rotations. The handbook is
designed to provide overall guidelines and requirements for student performance and
conduct. While it is expected that you follow this handbook diligently, there may be times
when additional information and guidelines are provided which add to or complement what is
already in the handbook. Students are responsible for knowing and adhering to all of the
information in this handbook.

The Student Clinician Handbook is divided into sections as outlined in the Table of Contents.
Part I provides clinic education requirements. Part II provides specific information on
evaluations, policies, and standards. Part III contains information on clinic competencies and
forms that will be needed during the clinical rotations.

Students should keep all completed forms and copies of clinic related paperwork in this
handbook. Originals are to be turned in to the clinic registration staff. The handbook is
designed to be a helpful guide and a means of record keeping. It is important that you use it
in this manner.

This handbook supercedes all previous versions and editions. Policies and procedures
contained in this document are subject to change at any time. The clinic contract found in
Appendix #1 must be signed by each student and a signed copy brought to the registrar’s
office prior to eligibility for entrance into the clinic.




                                          Page 12
DEPARTMENT OVERVIEW

ACUPUNCTURE AND ORIENTAL MEDICINE
The Acupuncture and Oriental Medicine (AOM) Department was established in 1988. A
new AOM wing of the Natural Health Clinic opened in 1993 to provide room for
continual growth in the department. In addition, the Chinese Herbal Medicine
Dispensary opened in 1994 to provide the full-time component for the Chinese Herbal
Medicine clinical training. In Spring 1999, the AOM clinic was relocated to the third
floor of the Natural Health Clinic. The AOM clinic now has nine acupuncture treatment
rooms, several preview/review rooms, a library, and a suite of Clinical Faculty offices.
The third floor is also home to the CHM dispensary. Students in the AOM programs
may also participate in patient care opportunities at three off-site clinics: Rainier Valley
in South Seattle, Highland Park in West Seattle, and King County Medical Clinic in
Issaquah.

Unique aspects of the AOM clinical program include a strong case management focus
implemented as case previews and reviews, inter-clinic multi-disciplinary referrals (ND,
Nutrition, Physical Medicine, Homeopathy, etc.), and supervision by highly
skilled/qualified acupuncturists and Chinese Herbalists in the region.
We hope that your clinical experieince in the AOM department is a rewarding one. We
would also encourage you to consider the following quote from the Nei Jing as a guide
for your medical education here at Bastyr Natural Health Clinic:

“Alas, the way of healing is so profound. It is deep as the oceans, and boundless as the
skies. How many truly know it? When sages practiced medicine, they were certain to
have understood the laws of nature and principles of disease, to master diagnosis, to have
been well learned in herbal medicine, and to have attained insights into human
relationships and individual temperament. As a result, they delivered their medicine in a
thoroughly holistic way.

“The key to effective medicine is to determine the cause and rectify the imbalance of the
Yuan [original] qi of the body. Study the ancient medical classics well. Follow the
correct treatment principles and perform your healing with the utmost care and attention.
Conduct yourself with the highest virtue and always have compassion toward your
patients. In this way you will be outstanding in your cures. This is the way of the sage
physician.”

Welcome to the beginning of your journey.

AOM CLINICAL PROGRAM MISSION:

The AOM clinical program is designed to integrate the rich history of traditional Chinese
medical methods with the study of modern sciences and the contemporary practice of
acupuncture and oriental medicine.



                                         Page 13
NATUROPATHIC MEDICINE

The naturopathic clinical program provides training in general naturopathic practice for
naturopathic medical students of Bastyr University. This training comprehensively
covers core naturopathic modalities, including General Medicine, Physical Medicine,
Homeopathy, and Lifestyle counseling.

Naturopathic medical students at Bastyr Clinic progress through their training in
observing, supporting, and then managing roles. Each role assumes increasing
responsibility for patient care. Prior to graduating, students are able to safely,
competently, and efficiently direct all aspects of patient diagnosis, treatment, and
management in a general care setting. Emerging from naturopathic clinical training, each
clinician will exemplify the integration of conventional medical knowledge and skills
with traditional naturopathic principles of healing. At the core of this integration is the
self-reflective and self-empowered desire on the part of each clinician to provide the
highest quality of care to each and every one of their patients. The naturopathic clinical
program provides the finest education available in training primary care naturopathic
physicians.

NATUROPATHIC PROGRAM CLINIC MISSION:
To train naturopathic physicians who are imbued with an understanding of how to
clinically apply the healing power of nature and the principles of naturopathic medicine.

NUTRITION
The nutrition program is founded upon the holistic origins of the Greek word diaira
(diet), "made of life," and Latin diaeta, "daily fare." The emphasis of the program,
therefore, is to incorporate physiological, biochemical, socioeconomic, political and
psychological aspects of human nutrition and physical activity in the preparation of
graduate students for roles as professional nutrition consultants. A unique emphasis on
whole foods and multicultural, political and ecological dimensions of the diet offer career
preparation for food programs, outpatient clinic settings, or independent practices. The
concepts of food as medicine and diet as a critical component in healing are fundamental
to natural therapeutics, optimal health and whole-person healing.

Nutrition Clinical Program Mission:
The mission of the nutrition program of the Bastyr Center for Natural Health is to
provide excellent training and prepare students to become skilled nutrition clinicians.
Students will be able to provide knowledge, skills, and expertise necessary to help
patients achieve and maintain optimal health and healing through informed food choices
by incorporating the program's whole, natural foods philosophy.




                                         Page 14
PROGRAMS OF STUDY

Acupuncture and Oriental Medicine
The AOM Program currently runs three clinical programs:
      Masters of Science in Acupuncture (MSA)
      Masters of Science in Acupuncture and Oriental Medicine (MSAOM)
      Chinese Herbal Medicine Certificate in Chinese Herbal Medicine (CCHM)

Naturopathic Medicine
Doctorate Degree Program in Naturopathic Medicine (ND)


Nutrition
The Nutrition Program currently offers two clinical programs:
       Masters of Science in Nutrition – Counseling track (MS)
       Bachelors of Science – Didactic Program in Dietetics (DPD)

CLINICAL FACULTY BY PROGRAM

AOM Clinical Faculty
Following are the AOM Teaching Clinical Faculty. All are Washington State licensed
acupuncturists:

AOM Core Clinical Faculty
Qiang Cao, ND, L.Ac. - Acupuncture, Chinese Herbal Medicine
Terry Courtney, MPH, L.Ac. – Acupuncture - Chair, Acupuncture and Oriental Medicine
Program
Wei Yi Ding, RN, L.Ac - Acupuncture, Chinese Herbal Medicine
Steve Given, MS, L.Ac. – Acupuncture, AOM Clinic Department Coordinator
Chongyun Liu, L.Ac. - Acupuncture, Chinese Herbal Medicine
Yajuan Wang, L.Ac. – Acupuncture, Chinese Herbal Medicine
Ying Wang, L.Ac. - Acupuncture, Chinese Herbal Medicine
Andrew McIntrye – Acupuncture, Chinese Herbal Medicine
Hazel Philp, AOM, ND dual track

AOM Adjunct Clinical Faculty:
Jim Dowling, M.Ac., RN, L.Ac., Acupuncture
Matt Ferguson, MS, L.Ac. – Chinese Herbal Medicine
Susan Heideke, MS, L.Ac. - Acupuncture
Kayo King, L.Ac. – Acupuncture
Yuanming Lu, MS, L.Ac. – Acupuncture, Chinese Herbal Medicine
Tuan Nguyen, MS, L.Ac. - Acupuncture
Benjamin Apirakchai, MS, L.Ac. – Acupuncture
Tong Lu, L.Ac.- Acupuncture
Yuanming Lu, L.Ac. – Acupuncture
Kate Yonkers, MS, L.Ac. - Acupuncture
Jana Rome, MS, L.Ac. - Acupuncture


                                        Page 15
ND CLINICAL FACULTY

Following are the naturopathic clinic faculty. All members are licensed in Washington State:

ND Core Clinical Faculty
Lise Alschuler, ND - Clinic Medical Director
Jana Nalbandian, ND
Keith Grieneeks, PhD - Counseling
Mark Groven, ND - Physical Medicine clinic coordinator
Jane Guiltinan, ND - Dean of Clinical Affairs
John Hibbs, ND - Naturopathic Program Coordinator
Eric Jones, ND
Andrew Parkinson, ND
Bill Roedel, PhD - Counseling
James Wallace, ND
Kevin Conroy, ND
Richard Mann, ND, Homeopathy
Karim Abdullah, ND
Hazel Philp, ND, L.Ac.
Melissa McClintock, ND

Adjunct ND Clinical Faculty
Joann Dechant, ND
Jill Fresonke, ND
Maryann Ivons, ND
Mark Lamden, ND
John Little, ND
Nancy Mercer, ND
Lauren Oktay, ND
Brian Peters, ND
Kasra Pournadeali, ND
Dirk Powell, ND
Marian Small, ND, L.Ac., RN


NUTRITION CLINICAL FACULTY
Following are the nutrition clinical faculty. All members are licensed in Washington State:
Jim Gallagher, MS, RD – Nutrition Department Coordinator, core faculty
Adjunct faculty:
Ann Fittante, MS, RD, CDE




                                          Page 16
CLINIC EDUCATION REQUIREMENTS

PREREQUISITES TO CLINIC ENTRANCE BY PROGRAM

AOM Prerequisites to Enter Clinic
Observation Status:
   1. Must be matriculated into the AOM program.
   2. Must complete and demonstrate passing grades in all required first quarter AOM
       academic classes.
   3. Must complete and have a passing grade in Clinic Entry.
   4. Must complete a Washington State Patrol criminal background check.
   5. Must complete TB screening/Hepatitis immunization or waiver (see page 102).
   6. Must have a current CPR for Health Care Providers card.
   7. Must complete signed clinic contract, which must be on file with the registrar.

For Internship Status:
   1. Must have completed 4 observation shifts.
   2. Must be matriculated in the MSA or MSAOM degree program and have
        successfully passed all required courses in the first 5 quarters of AOM and basic
        science curriculum and be in good academic standing.
   3. Must have a current CPR for Health Care Providers card.
   4. Must have passed the CCAOM Clean Needle Technique exam and the AOM
        Clinic Entry exam with a minimum score of 80.
   5. The Clinic Entry Exam may only be attempted once per quarter. If a second
        failure occurs, this will require a meeting with the student’s academic advisor in
        consultation with the AOM Program Chair. A learning contract will be
        established which may require a student to retake a class(es) or other remedial
        measures. Successful completion of the learning contract must be accomplished
        before a retake. A third failure places the student in academic probation, which
        may lead up to and include dismissal from the AOM program.




                                         Page 17
CLINIC ENTRY COURSES

1. AOM Clinic Entry (NOTE: beginning in Fall 2000, AOM Clinic Entry 1 and Clinic
    Entry 2 are to be combined.)
Prerequisite: AOM Enrollment
Credits: 2.0
Hours: 1.0/week 22 total hours
Required Text: Student Clinician Handbook

2. Course Objectives:
      a.     The student will gain a perspective on clinic purpose and function.
      b.     The role of the observer and intern clinician will be clearly defined.
      c.     The student will be introduced to skills that will allow her/him to become
             familiar with case management, including charting.
      d.     The student will be introduced to the paperwork and paper flow in the
             clinic.
      e.     The student will know the role of each person in the clinic structure and
             how she/he will interact with these people.
      f.     The student will learn the clinic policies, procedures, protocols and
             clinical education requirements.
      g.     The student will be exposed to the ethical and moral issues of acupuncture
             and clinical practice and how these issues relate to the clinic as a whole
             and to each person as an individual within the clinic.
      h.     The student is encouraged to continue to develop and broaden her/his own
             personal philosophy of AOM.
      I.     To provide the students with exposure to and experience with the
             medicine they are studying.
      j.     To prepare students for entry into the clinic.

3. Syllabus:
       Week 1:       Introduction, blood borne pathogens
       Week 2:       Patient visit procedures
       Week 3:       Clinic tour
       Week 4:       Critical thinking and assessment
       Week 5:       Critical thinking and assessment
       Week 6:       Evaluation, assessment, management, referrals
       Week 7:       Charting, privacy, ethics
       Week 8:       CNT, Risk management
       Week 9:       Clinical research
       Week 10:      Presentations
       Week 11:      Final.                 (All classes are 2 hours.)




                                       Page 18
4. Course Requirements:

     Course introduced in classroom                     2.0 hr
     First Office Call: Acupuncture                     1.5 hr.
     Second Office Call: Chinese Herbal Med.            1.5 hr
     Return Office Visits 1.0 hour each)                2.0 hr
     2 case previews                                    1.0 hr
     2 case reviews                                     1.0 hr
     End of Quarter Class Session                       2.0 hr

5. A clinic entry journal is required of all students as well as a summary statement of
   learning to be turned in at the final class meeting.
6. Students will receive a CE tracking sheet that will be record of the requirements for
   the class. It will need to be initialed and dated where appropriate and included in
   your clinic entry journal.
7. Students must receive a grade of AC or better to enter the clinic.
8. This course is designed as an experimental class for the student. A student can
   choose to have a wellness program designed if there are no specific health concerns to
   be addressed.
9. The required text for this course is Acupuncture Risk Management, by David Kailin.


1.        ND CLINIC ENTRY I
            a. This course is registered and paid for the 1st quarter of the 1st year of the 4
               and 5 year track and is to be completed by the end of Spring Quarter of the
               first year.
            b. Credits:        1.0
            c. Hours:          14.5

2.        Course Objectives:
     a.   To provide students with a well-rounded experience with the Bastyr Center for
          Natural Health, from a patient’s perspective. This course is designed as an
          experiential class for the student. Students can choose not to receive the
          recommended treatment. A student can choose to have a wellness program
          designed if there are no specific health concerns to be addressed, or if the student
          prefers not to use recommended treatments.
     b.   To provide the students with exposure to and experience with the medicine they
          are studying.
     c.   To prepare students for Clinic Entry II, the next prerequisite for entry into the
          clinic after achieving competency in CE 1.
     d.   To expose students to basic medical terminology




                                            Page 19
3.   Course Requirements:
           a. Quarterly and Final all-class meeting between Students and Instructor: 4.0
              hour
           b. First Office Call:             1.5 hr
           c. Return Office Call:            1.0 hr
           d. Nutrition Specialty Clinic     1.0 hr
           e. A second Return Office Call either in Patient Care, Nutrition, or a First
              Office call in
              Homeopathy                     1.0 hr.
           f. Counseling Session:             3.0 hr

         (includes 3 visits - these will be done at the student counseling center at the main
        campus)

             g.   3 case previews:     1.5 hr
             h.   3 case reviews:      1.5 hr
             i.   medical terminology exam



     4. Each student will be required to write three evaluative papers, discussing their
         experience in the clinic. These papers are to be turned in to the CE I Instructor at
         the quarterly and final meetings.
     5. Students will receive a CE I tracking sheet that will be a record of the
         requirements for the class. It will need to be initialed and dated where
         appropriate.
     6. The CE I instructor will meet with the class as a whole during scheduled one hour
         meetings at the beginning of Fall, Winter and Spring Quarters to answer questions
         and share information pertinent to the class.
     7. The class will meet with the Instructor at the end of Spring Quarter for a final
         discussion group. Course tracking sheets, student essay, and final examination
         are due and should be turned in together at this time.
      8. There will be a written medical terminology exam during the year.




                                          Page 20
ND CLINIC ENTRY II

1           Prerequisites:
            a. ND Clinic Entry I
            b. The student in the four-year program is required to have completed all first
                year courses and Fall and Winter second year classes in order to receive an
                AC in Clinic Entry II. The student in the five-year program is required to have
                completed all 1st and 2nd year courses and all Fall and Winter 3rd year courses
                in order to receive an AC in CEII.

2.          Credits:       1.0

3.          Hours: 1 hr./week; 11 total hours

4.          Required Text:         Student Clinician Handbook

5.          Course Objectives:
     a.     The student will gain a broader understanding of Naturopathic Medicine as it
            relates to clinical practice.
     b.     The student will gain a perspective on clinic purpose and function.
     c.     The role of the 3rd year student clinician will be clearly defined
     d.     The student will be introduced to skills that will allow her/him to become familiar
            with case management, including charting, as performed in the Bastyr Center for
            Natural Health Clinic.
     e.     The student will be introduced to the paperwork and paper flow in the clinic.
     f.     The student will know the role of each person in the clinic structure and how
            she/he will interact with these people.
     g.     The student will learn the clinic policies, procedures, protocols and clinical
            education requirements.
     h.     The student will be exposed to the ethical and moral issues of medicine and
            clinical practice and how these issues relate to the clinic as a whole and to each
            person as an individual within the clinic.
     i.     The student is encouraged to continue to develop and broaden her/his own
            personal philosophy of Naturopathic Medicine.

6.        The student will be required to pass a clinic entrance exam in order to receive an
          AC in Clinic Entry II.

7.        Student must receive a grade of achieved competency in CE II in order to enter the
          clinic.

8.        Student must purchase required medical equipment, ordered in this course, prior to
          entry into the clinic.




                                             Page 21
ND Prerequisites to Enter Clinic
1. Students must complete and achieve competency in all required first and second year
   classes of the 4-year track or all required classes in the first, second, and third years
   of the 5-year track, prior to entering clinic. Students must be in good academic
   standing in order to begin the clinical training portion of their program. Questions
   about didactic prerequisites for ND students should be addressed to Kathy Klompeen
   (Main campus, room 249, 425-602-3012).

2. Students must complete and achieve competency in Clinic Entry I, or equivalent
   course.

3. Students must complete and achieve competency in Clinic Entry II, or equivalent
   course. Clinic Entry II includes a clinic entrance exam, which the student must pass.

4. All Advanced Standing/Transfer Students must meet all clinical training
   requirements. Advanced Standing/Transfer Students must be in good academic
   standing. Advanced Standing students will not be granted waivers of any clinical
   training credits, hours, or other requirements.

5. Students must have proof of completion of a course equivalent to the 49-hour Red
   Cross course entitled “Emergency Response/Professional Rescuers Level C-CPR” or
   equivalent experience. Questions about what constitutes eligible equivalent
   experience should be addressed to Dr. John Hibbs (Clinic, 206-834-4158). A copy of
   the current CPR/First Aid card, or written record of the approval to substitute
   equivalent experience for the current CPR/First Aid card, must be turned in to the
   clinic registration office (Main campus, room 249, 425-602-3403).

6. Students must complete a Washington State Patrol (WSP) criminal background
   check. There is no charge for this service. Forms will be distributed to all students
   enrolled in Clinic Entry II. Forms are also available in the Registrar’s office.
   Questions about the WSP background check should be addressed to Tamerlane Witt
   (Main campus, room 249, 425-602-3403).

7. TB screening and Hepatitis immunization forms or waivers must be turned in to
   Sabine Thomas, Site Safety Coordinator. Questions about TB screening and Hepatitis
   immunization should be addressed to Sabine Thomas (Main campus, room 7, 425-
   602-3250).

8. A signed Clinic Contract, Appendix 1 of the Student Clinician Handbook, must be
   turned in to the clinic registration office.

9. All ND students must complete 44 hours of preceptor experience (one completed
   credit of preceptorship) prior to the start of their first quarter in the clinic. Preceptor
   packets with full instructions are available from the wall display outside of the
   Registrar’s office and from Jeanne Deller, Preceptor Coordinator. Questions about
   preceptorships should be addressed to Jeanne Deller (Clinic, 206-834-4103).

                                           Page 22
10. All ND students who started their clinic during or after summer 2000 must be
    enrolled in at least one (1) Patient Care shift during all quarters in which they are
    clinic eligible. This includes summer quarters. Exceptions to this quarterly clinic
    attendance policy are reserved for extenuating circumstances. Students who do not
    register for clinic in any given quarter will likely delay their graduation. Students
    who entered in 1999 and are on the 5A track do not have the requirement to be in
    clinic in their first summer. To apply for a leave of absence from the University,
    contact Aracelly Salazar (Main campus, room 249, 425-602-3011).

11. Clinic registration forms will be placed in the main campus student mailboxes of all
    clinic eligible students. Clinic registration forms must be turned in to the Registrar’s
    office by the established deadline, as listed on the form. If you are clinic eligible and
    do not receive a clinic registration form, contact the clinic registration office
    immediately.

12. For students enrolled in the University in 2000 or later, must have completed 44
hours of preceptorships prior to beginning in the clinic


NUTRITION CLINIC ENTRY

Course Description:
This course prepares students for clinic by reviewing clinic requirements, protocols, and
standards of care and practice. Students will become familiar with clinic paperwork.
Expectations and roles are clearly defined. The majority of the course is a self-study
where students work at their own pace. The course includes a series of presentations by
clinic faculty and staff. Students will spend time observing nutrition clinic shifts as well
as personally experiencing the clinic from a patient's perspective. Students take a clinic
entry exam at the end of the course and will need to pass the exam before being eligible
to enter clinic.

   a. Prerequisites: BC5118, BC5119, TR5120, TR5210, PS5204, PS5210 (co-
      requisite), TR5404 (co-requisite)
   b. Credits: 1.0
   c. Required Text: Student Clinician Handbook




                                          Page 23
AOM SUMMARY OF CLINIC REQUIREMENTS (MSA AND MSAOM)

Following is a summary of the requirements students will need to meet in order to
graduate and be eligible for NCCAOM diplomat status and Washington State
acupuncture licensure (L.Ac.):

AOM Clinic Observation Internship
Clinic prerequisites:
    1. Successful completion of Clinic Entry I.
    2. AOM enrollment and good academic standing with passage of all required first
        quarter classes.
    3. Current CPR for Health Care Providers card
    4. Completion of Observation Check-off Form

Credits/Shifts:
Credits:      8 total (1 credit = 22 hours; 2.0 credits per shift)
Shifts:       four 2-credit shifts plus 0.5 credits (12 hours) interim clinic
Hours:        188 total hours

AOM Clinic Primary Internship
Internship prerequisites:
   1. Must have successfully completed 4 observation shifts
   2. Must be matriculated in the MSA or MSAOM degree program and have
       successfully completed the first 5 quarters of AOM and basic science curriculum
       and be in good academic standing.
   3. Must have a current CPR for healthcare providers card, must have passed the
       CCAOM Clean Needle Technique exam and passed the AOM Clinic Entry exam
       with a minimum score of 80%.

Acupuncture Intern B and Acupuncture Intern A:
   1. Acupuncture Intern B (AIB): after successfully passing the Clinic Intern Entry
      Exam, the student will enter internship as an Acupuncture Intern B. During the
      first 100 patient treatments supervisors will closely observe and guide the
      clinician. When the AIB nears his or her 100th treatment an evaluation is required
      with the AOM Clinic Program Coordinator.

   2. Acupuncture Intern A (AIA): After the AIB successfully completes the first 100
      treatments and had been evaluated, and given recommendation to continue, they
      may proceed through internship with more autonomy but continued consultation
      and assistance of the supervisors. A minimum total of 300 additional patient
      treatments are expected of students who have achieved Acupuncture Intern A
      status (a total of 400 patient treatments is required by AOM Interns).

   3. A standardized patient clinic exit examination may be a requirement for
      graduation for students entering clinic during ’02-’03. This exam will be offered


                                         Page 24
       during the winter of a student’s final year in clinic. Students will be given the
       opportunity to remediate this exam if necessary.

Following is a breakdown of the requirements for shifts, hours, and patient contacts:
Shifts:
    1. MSA: Fourteen 2-credit shifts plus 1-credit (24 hours) interim clinic for MSA.
    2. MSAOM: Fourteen 2-credit shifts plus 1-credit (24 hours) interim clinic and 8 2-
        credit Chinese Herbal Medicine shifts plus a 2-credit dispensary shift and a 2-
        credit clinic project for MSAOM.

Credits/Hours (AOM) :
   1. MSA: 38 credits/836 hours (1 cr. = 22 hours)
   2. MSAOM: 56 credits/1232 hours (1 cr. = 22 hours)

Clinic Outreach
16 hours of clinic outreach is required of all AOM students. (See section on Outreach for
description.)
AOM Outreach requirements for graduation:

   1. Hours: 16
   2. At least 4 hours must be completed by the end of Summer Quarter of the second
      year in clinic.
   3. At least 8 hours must be completed by the end of Fall Quarter of the second year
      in clinic.
   4. At least 12 hours must be completed by the end of Winter Quarter of the second
      year in clinic.
   5. Any remaining hours must be completed by mid-Spring Quarter of the second
      year in clinic.

Patient Contacts (AOM):
A total of 400 patient treatments/contacts is required by AOM interns.

   1. Intern A1B must perform 20 first patient interactions and 80 subsequent patient
      interactions over a minimum of 3 academic quarters and 5 clinic shifts.
   2. Intern A1A must perform 300 additional patient interactions.




                                         Page 25
AOM Shifts
  1. Full-time students taking internship are strongly advised to take only 2 internship
     shifts for their first quarter. Remaining quarters should average 2-3 shifts per
     quarter. No less than 2 shifts and no more than 4 shifts can be taken per any given
     quarter. Students must register for clinic shifts during every quarter in which they
     are clinic eligible and enrolled at Bastyr University. Exceptions to this quarterly
     clinic attendance policy are reserved for extenuating circumstances. Failure to
     register for clinic shifts will likely delay a student’s graduation date.

   2. China Externship Option: Approved sites only. Up to 8 credits of internship may
      be registered for in the China externship program. AOM Program Chair will
      review patient contacts. China Externship requires application and good
      academic standing. Third year is the preferred time for the China Externship.

   3. External Clinic Shift (formerly Advanced Preceptorship): Up to 2 credits of
      External clinic shift may be available to students with strong academic standing.
      As with observation, External clinic shift hours are 44 per 2 credits. For more
      information contact Clinic registration staff.

   4. External Clinic Sites: The AOM Clinical program currently offers several clinical
      training sites outside of the Natural Health Clinic. These sites include Rainier
      Park Medical Clinic, Highpoint Medical Clinic, and Redmond Community
      Medical Clinic. Observation students must be in their 3rd observation shift before
      registering for an off-site clinic. Interns in good academic standing are eligible
      for registering for off-site clinic opportunities. It is strongly preferable that a
      student be in at least their 5th intern shift before registering for an off-site clinic.
      Students with less experience as either an observer or intern must have the written
      pre-approval of the supervising Clinical Faculty and the AOM Clinic Program
      Coordinator before registering for an off-site clinic shift.

Specialty Clinics:
At present the BCNH runs the following specialty clinics within AOM department:
   1. Immune Wellness Clinic: A clinic option focusing on HIV and AIDS. Students
       are asked to commit to 3 consecutive quarters. There is an emphasis on integrated
       therapy and education in the field of AIDS.
   2. Herb Clinics: Third year MSAOM or Certificate of Chinese Herbal Medicine
       students only are allowed into the Herb Clinic shifts.
   3. AOM/ND Integrated Shift: This shift combines AOM clinic with ND clinic under
       the supervision of a licensed ND, L.Ac. for students entered in both AOM and
       ND programs. Credit will be given for AOM hours and contacts only.




                                         Page 26
MSAOM and CCHM Herbal Clinic Requirements
Prerequisites
   1. CH 6803 CHM Clinic 1 (observation) may be taken concurrently with Materia
      Medica 1 – 3.
   2. Must have completed CH 5411, 6412, 6413 (Materia Medica 1 – 3) prior to
      starting as an Intern.

Herbal Clinic Intern:
   1. Credits: 16 credits over no less than one academic year
   2. Shifts: 8 2-credit shifts including interim coverage
   3. Hours: 352



Herbal Dispensary:
This two-credit course is designed to teach, in a practical hands-on method, the art and
science of preparing and dispensing Chinese herbs. Students may register for dispensary
any time after their Herbal Medicine Curriculum has begun.

CHM Clinical Project:
Students are required to do a clinical project related to Chinese Herbal Medicine.
(2 credits)




                                        Page 27
SUMMARY OF ND CLINIC REQUIREMENTS

Following is a summary of the requirements students will need to meet in the
Naturopathic Degree Program order to graduate and be eligible to sit for board
examinations:
Total number of shifts:     25 (includes patient care, clinic assistant, preceptorship)

Total number of hours:         1,244.5 (includes patient care, clinic assistant,
preceptorship, interim clinic, clinic grand rounds, and outreach/community education)

Total number of patient contacts: 350 (includes patients seen in the clinic: in general
patient care, homeopathy, counseling and physical medicine, sub and extra hours, interim
clinic, float rooms). This does not include patient contacts seen in preceptorships.

Following is a breakdown of the requirements for shifts, hours and patient contacts:
1. Shifts (ND):
    a) Patient care shifts: 21 (17 general patient care, (includes up to 2 counseling, and
       may include up to 4 homeopathy), and 4 physical medicine.
    b) Clinic lab diagnosis (campus) (3Q, 2hr/wk lab) Total credit 3 cr/Q including
       class
    c) Preceptorship shifts: 3 (to be done in doctors/health care professionals/clinics
       outside Bastyr Center)
    d) Interim patient care (44 hours)

2. Hours:
   a) Clinic Entry I and II –                           25.5 hr. (2 credits)
   b) Patient care hours                               924
   c) Clinic lab dx (1.5assistant hours)                99
   e) Preceptorship hours:                             132
   f) Interim clinic hours:                             44
   g) Interim clinic is registered as interim patient care
   g) Clinic Outreach                                    20
                      Total Hours                     1244.5
3. ND and dual enrolled students Outreach (ND) requirements for graduation:

   a. Hours: 20
   b. At least 5 hours must be completed by the end of Winter Quarter of the first year
      in clinic.
   c. At least 10 hours must be completed by the end of Summer Quarter of the second
      year in clinic.
   d. At least 15 hours must be completed by the end of Winter Quarter of the second
      year in clinic
   e. Any remaining hours must be completed by mid-Spring Quarter of the second
      year in clinic.



                                        Page 28
4. Patient Contacts (ND):
   a. Students need a minimum of 350 patient contacts in the 21 patient care shifts,
      interim clinic, sub and extra hours, a minimum of 175 must be primary contacts.
   b. This averages to 16.7 patients for each of the 21 shifts and would be less when
      including patients seen on interim clinic, and during sub and extra hours
   c. This averages to about 1.5 patients for each 4 hour shift
   d. Student may include preceptor contacts in their total primary patient contacts only
      with the approval of their clinic advisor. Each contact is evaluated by the advisor
      regarding the degree of hands-on case management by the students in order to
      determine sufficiency for primary patient contact credit.
   e. Students in their 1st year of clinic cannot be registered for more than 6 shifts for
      the year.


5.   Credits:
       a)       Clinic entry I and II        2 credits
       b)       Patient care shifts:         42 credits
       c)       Clinical lab diagnosis       9 credits including class
       d)       Preceptor shifts:            3 credits
       e)       Interim clinic:              2 credits
       f)       Outreach                     Hour requirement

6. The following must occur for completion of the clinical training program:
      a. A grade of AC must be achieved for each clinic shift.

       b. All Clinical Competencies must be signed-off by supervising Clinical Faculty.

       c. All Clinical Hours must be completed, all patient contact requirements must
          be met, and all required paperwork must be completed and submitted.

       d. A standardized patient clinic exit examination may be a requirement for
          graduation for students entering clinic during ’02-’03. This exam will be
          offered during the winter of a student’s final year in clinic. Students will be
          given the opportunity to remediate this exam if necessary.


7. A student will NOT receive their degree until all requirements are met at a level
of achieved competency and the Clinical Faculty recommends the student for their
ND degree.




                                         Page 29
ND PATIENT CARE (PC) SHIFTS AND CLINICAL LAB DIAGNOSIS
ROTATIONS

1.     Prerequisites
       a. Successful completion of Clinic Entry II (ND) and signed clinic contract.
       b. ND Program enrollment and good academic standing, with achieved competency
           of all required second year classes, for 4 year track students, and third year
           classes, for all 5 year track students.
       c. Current CPR card and completion of Emergency Response/Professional Rescuers
           level c-CPR or equivalent course.
       d. Washington State patrol background check.
       e. TB screening/Hepatitis immunization or waiver
       f. 44 hours of preceptorships completed (for all students who began their clinic
           shifts during or after summer 2001).
2. Patient Care includes general patient care, physical medicine, homeopathy specialty
   shift and counseling specialty shift.
3. Clinical laboratory diagnosis 1 –3 is offered on campus.

4. Required for patient care:

     a. 21 patient care shifts (includes patient care shifts #1-17, one of which is a pre-
        assigned counseling shift (see counseling shift guidelines) and physical medicine
        shifts #1-4)

     b. It is required that each student be enrolled in at least one patient care shift every
        quarter that they are clinic eligible. Exceptions to this quarterly clinic attendance
        policy are reserved for extenuating circumstances. Failure to register for clinic
        shifts will likely delay a student’s graduation date.

     c. External Site clinics, currently consisting of: Community Health Clinic of
        Redmond, Covenant Shores Nursing Home, 45th St. Homeless Youth Clinic,
        HOC Bothell, and the Northwest Center for Optimal Health, may fulfill a
        student’s patient care requirements. These sites may change from time to time as
        the external site program is expanded or modified.

     d. A student may request an advanced preceptorship in place of a regularly
        scheduled patient care shift if they have successfully completed at least eleven
        patient care shifts, have completed all of their required preceptorships and are in
        good academic standing. The student must submit a written request describing
        the external site to the Clinic Medical Director. This letter must be accompanied
        by a letter from the supervisor/physician on the external site describing the nature
        of their practice and the nature of the students proposed experience. Please refer
        to the ND and AOM Advanced Preceptorship, page 36 of this handbook, for the
        complete description of these requirements.




                                          Page 30
5. Required for clinic laboratory diagnosis:
   a. 1 lab rotation
   b. 66 hours (99 hours, including class
   c. This lab rotation occurs on campus

6. Interim clinic requirements: (Patient Care 17)
    a. All 44 hours must be done in Patient Care or Physical Medicine.
    b. Students will be scheduled for Interim according to the preceding quarter shift
        schedule, and are responsible for attending the same weekly shifts that they were
        on during the preceding quarter. Students must complete their required interim
        hours over several interim periods. Unapproved absences during interim will
        count as unapproved absences and will result in a requirement to make up the 4
        hours missed plus an additional 12 hours of clinic shifts for each missed shift.
    c. Students will be automatically registered for PC 17 Spring Quarter of their
        graduating year. An AC for PC 17 depends upon successful completion of all
        required interim shifts.

7. No more than 4 shifts can be taken in homeopathy (see additional shift request, #10
below)
    a. Prerequisites must be completed prior to entering a specialty shift. (Homeopathy
       classes 1-4).
    b. Clinic Department Chair/Supervising Clinical Faculty approval must be granted
       in order to be on a specialty shift related to that department
    c. All students who are registered for a shift should be in Homeopathy Grand
       Rounds. Other students may enroll in Grand Rounds with special permission of
       the instructor.


8. Students need to take 2 physical medicine shifts each year, for a total of 4 shifts. (See
additional shift request, #10 below.)
   a. Only 1 physical medicine shift should be taken in any one quarter.
   b. Prerequisites must be met before taking physical medicine shifts.

9. Students must be registered for a minimum of 1 shift, but preferably 2 shifts, and a
   maximum of 4 shifts, per quarter in any quarter in which they are clinic eligible and
   enrolled at Bastyr University. At least one of the assigned quarterly clinic shifts must
   be a patient care shift for each student. Students may not be registered for more than
   2 shifts on any given day. Students wishing to take more than 4 shifts per quarter
   must submit a written request to the CMD prior to registration. (Subject to change as
   clinic intensive model is fully implemented.) Failure to enroll in a clinic shift will
   likely delay graduation date.




                                         Page 31
10. Students wishing to take additional specialty shifts beyond the maximum number
    (homeopathy, counseling, or extra physical medicine) must have requests to do so
    approved by the Medical Director. Written requests must be submitted to the Clinic
    Medical Director.

   a. Minimum and maximum amount of shifts: homeopathy 0- 4, counseling 1 - 2,
      physical medicine 4 – 6.

12. Students are strongly encouraged to take at least one external clinic shift during their
    clinical training.


ND COUNSELING SHIFT GUIDELINES
  1. Absences: All absences must be excused. All hours missed must be made up in
     counseling. This can be done through 1) interim clinic, or 2) if off-shift
     counseling privileges are given by the counseling supervisor (this is done by
     seeing a patient in a float room, if available, or during the counseling shift). A
     note signed by the counseling shift supervisor signifying approval for off-shift
     counseling is required to be in the student’s file at the CR’s office.

   2. Substitutes: Substitutes are not used when a clinician is absent from a counseling
      shift. Absence/sub paperwork procedure must still be followed, with the
      exception of leaving the “name of substitute” line blank.

   3. Off-Shift Counseling: Students who have completed a counseling shift may be
      given off-shift counseling privileges in order to continue counseling patients they
      have been working with on the counseling shift. This would include an allowance
      to see patients (one per patient care shift) outside of the counseling shift. Each
      patient must be assessed by meeting with the counseling supervisor prior to their
      first session (or during the first session). Students must meet with the counseling
      supervisor between each patient visit for supervision. A note signed by the
      counseling shift supervisor signifying approval for off-shift counseling is required
      to be in the student’s file at the CR’s office.

   4. Interim Shifts: Interim counseling shifts are available to those clinicians currently
      on a counseling shift, to those needing to make up any previous counseling
      absences, or if the need arises, by approval of the counseling supervisor. Only
      those who already have taken a counseling shift may sign up for an interim
      counseling shift.

   5. Second Shift Requests: Students wishing to take a second shift may do so
      depending upon the availability of openings. Sign up is through the Clinic
      registration staff. See Clinic Policy regarding taking more than the required
      amount of patient care specialty shifts. No more than 2 counseling shifts may be
      taken.


                                          Page 32
   6. Counseling Shift Assignments: Students will be randomly assigned a counseling
      shift, during their first clinical year, and must take the shift during the quarter
      assigned.

   7. Interaction Between Clinic and Counseling Center
          a. Counseling Center Student Staff Counselors will not provide counseling
              services in both locations (clinic services at the Natural Health Clinic and
              counseling services in the Campus Wellness Center), but must only
              provide counseling at the Campus Wellness Center.

          b. This policy is an attempt to safeguard both the student receiving services
             and the student clinician providing services from a potential conflict of
             interest, i.e. harassment, that could result from exposure in a dual role
             setting.

          c. Only under special circumstances will an exception be granted. The CEI
             student must submit the request in writing. The student’s staff counselor
             must also submit a statement in writing. The requests will be reviewed by
             the Counseling Center Director, the Clinic Medical Director, and all
             appropriate clinic shift supervisor (i.e. AOM, Counseling, ND, Nutrition,
             etc.) All involved reviewers must approve the request.

          d. Due to ethical consideration, student clinicians may not “self-refer”
             student clients to their own private practice, outside the NHC.

All Clinic eligible naturopathic students will be assigned a counseling shift.




                                        Page 33
NUTRITION CLINIC REQUIREMENTS

Following is a summary of the requirements students will need to meet in order to
graduate and be eligible to sit for board examinations. Nutritional counseling track
students complete 3 quarters of clinic practices. This is defined as follows:

1. Total number of shifts (Nutrition): 1 shift for BS-DPD students and 3 shifts for MS
   counseling track students

2. Interim clinic hours: 8 hours are required for MS Nutrition counseling, track
   students. These hours must be completed in order to graduate. All interim hours
   must be signed by the clinic supervisor and once completed, turned into the clinic
   registration staff.

3. Total number of hours (Nutrition): 44 hours per each shift

4. Total number of patient contacts (Nutrition): MS counseling track students must see
   10 patients as a primary and 15 patients as a secondary by the end of clinical
   practicum 3. There are no requirements for BS-DPD students.

5. The following must occur for completion of the clinical training program:

    a.   A grade of AC must be achieved for each clinic shift.

    b.   All Clinical Competencies must be signed-off by supervising faculty.

    c.   All Clinical Hours must be completed, all patient contact requirements must be
         met, and all required paperwork must be completed and submitted.

6. Nutrition Exit Exam. Students must pass the exit exam which is two parts:

           a. Video Taping – Student clinicians in their last quarter must have a FOC or
              FOC2 session videotaped and graded by the shift supervisor. The
              videotaped evaluation will be graded as pass/fail. If the shift supervisor
              notes deficiencies and gives a failure grade, the videotape will be
              independently evaluated by the Nutrition Clinic Coordinator or other
              designated nutrition faculty for a second opinion of the deficiencies. If
              disagreement regarding the grade still exists after the second evaluation,
              the Nutrition Department Chair will evaluate the videotape. If a failure
              grade is received, the student will have to enroll in an additional entire
              quarter or Clinic Practicum and repeat the videotaped patient appointment.
              The student will receive a notification letter approximately two weeks
              after the videotaped appointment of the grade result.



                                        Page 34
            b. Written Exam – An open book written examination will take place once a
               year at the end of Spring quarter. The examination will be three hours and
               will consist of three case studies. Students will be required to write a
               SOAP note for three case studies. Subjective information and parts of the
               Objective information will be provided. Students will have to complete
               the remaining Objective information, the Assessment, and Plan portions of
               the SOAP note. Students are responsible for all information contained in
               the clinic protocols standards for SOAP noting. The examination will be
               graded as pass/fail. The Nutrition Clinic Department Coordinator will
               grade the examinations. All three case studies must receive pass grades.
               If one or more of the case studies do not receive a pass grade, an
               additional case study, or studies, must be completed during final exams
               week the following quarter. If, for a second time, the case study, or
               studies, are failed, additional course work will be required at the discretion
               of the Nutrition Faculty. The student will receive a notification letter
               approximately two weeks after the written examination date of the grade
               result.


7.   A student will not receive their degree until all requirements are met and the clinic
     faculty recommends the student for their degree.

8.   Please note that Nutrition students are required to complete 8 hours of Interim clinic.
     Any additional hours completed during interim may be used to make up missed clinic
     weekly shifts.




                                          Page 35
INTERIM CLINIC

Interim Clinic differs from regular clinic shifts, occurring at the end of a quarter in order
to provide on-going care for our patients during academic breaks.

You are RESPONSIBLE FOR SHIFT COVERAGE and are required to find
substitutes for your interim shifts if you will not be able to attend.

1. ND Interim clinic Requirements for graduation:
      a. Credits: 2
      b. Hours: 44

To be completed over the course of all weeks of Interim clinic.
Note: students are automatically registered for Interim Clinic credits (2) during the
Spring Quarter of their fourth year. This will appear on registration form as interim
patient care.

2. AOM Interim clinic Requirements for graduation:
     Requirements for observation:
     a)     credits: 0.5
     b)     hours: 12
     Note: To be completed over the course of all weeks of Interim clinic.

      Requirements for Internship:
      a)     credits: 1
      b)     hours: 24
             To be completed over the course of all weeks of Interim clinic.
Note: students are automatically registered for Interim Clinic credits (2)

3. NUTRITION: Interim Clinic- Requirements for graduation:
   Nutrition students are required to complete 8 hours for Interim. Additional hours
   completed during interim may be used to make up missed clinic shifts.

Interim clinic is currently offered during the following times:
Winter break, between Fall and Winter Quarter *(2-3 weeks)
Spring break, between Winter and Spring Quarter* (1 week)


*PLEASE NOTE: Due to Calendar changes, Interim weeks are subject to change
without notice. Please be advised of this possibility and plan to complete this
requirement as early as possible during the program.




                                          Page 36
4.Patients seen during interim clinic on patient care shifts are counted towards the total
number of patient contacts. Students should use the Patient Summary Form to keep a
record of the patient contacts. In the ND program, all 80 hours must be in Patient
Care/Physical Medicine.

5. Additional interim hours [above the 44 hours (ND) or 36 hours (AOM) or 8 hours
(Nutrition)] can be used to make up shift hour deficits from the current or past quarters.
These hours should be tracked on the Substitute and Extra Form, and patient contacts on
the Summary of Patient Contacts Form.

6. Students will be responsible for interim clinic shifts during the same days/times they
were scheduled for shifts during the preceding quarter. Absence requests must be
approved by supervisor and submitted two weeks prior to the start of the interim period.
Additional shifts may be requested and taken during the interim period, if desired.

7. At the end of each interim clinic period, all paper work must be turned in to the Clinic
registration staff to receive credit.

8. Unexcused Absences during Interim Clinic will result in a requirement to make up the
4 hours missed plus an additional 12 hours of clinic shifts for each missed shift. These
hours are in addition to the required interim hours for each program.

9. ND/AOM dual-track students need to complete 44 hours of ND interim clinic and 36
hours of AOM interim clinic.




                                         Page 37
NATUROPATHIC PRECEPTORSHIP PROGRAM

Preceptorships are for the purpose of providing observational, hands-on, or limited
hands-on experience with established practitioners outside of the Bastyr Center for
Natural Health. You have the option of working with pre-approved preceptors in either
private practice or other community settings.

Note: Please copy all completed forms (for your personal files) prior to turning original
documentation in to your Placement Coordinator.


        1.       Establishing Preceptorships:

             a.) All preceptors must be PRE-approved, prior to beginning
                 Preceptorships, to insure credit hours and Bastyr liability coverage.
                 Preceptor Site Information is available on the intranet, Bastyr Clinic
                 and Campus libraries—access through Internet Explorer with
                 http://precept/. This data includes preceptor’s name, location and phone
                 number, student requirements, and other relevant information. You may
                 contact a pre-approved preceptor (unless otherwise noted) or recruit a new
                 one.
             b.) ND Preceptor Application Forms, for new preceptors, are available in
                 your Placement Coordinator’s office.
             c.) ND Student Preceptorship Plan Form (attached)—needs to be turned
                 in prior to embarking on a preceptorship. This provides your
                 Placement Coordinator valuable information to be placed in your file
                 until remainder of packet is completed and turned in. You do not
                 need confirmation of approval when turning the Plan in. You will,
                 however, be notified if additional data is required.

   2.        ND Preceptorship Graduation Requirements/Options as follows:
             e. You must have a total of 132 hours (3 credits) of documented
                preceptorship experience.
             f. At least 88 preceptorship hours MUST be with an ND.
             g. You MAY have up to 44 hours credited with a non-ND.
             h. At least three different sites are required for your preceptorship credits.
             i. A minimum of 20 hours is required at any given site.
             j. If enrolled in 2000, or later, you MUST complete 44 hours prior to
                beginning clinic shifts.
             k. You are limited to 66 credit hours for preceptorships prior to beginning
                clinic shifts.

   3. All attached forms must be COMPLETED IN FULL, SIGNED, AND
      TURNED IN to your Placement Coordinator to receive credit. (No other

                                          Page 38
   forms/format accepted!) These forms must be submitted within a month of
   preceptorship completion for credit.
       e. Preceptorship Clinical Time Sheet
       f. Summary of Patient Contact Hours
       g. Preceptor’s Student Evaluation
       h. Student’s Evaluation of Preceptor
       i. Student’s Self-Evaluation
4. All registration for ND Preceptorship Credits will be approved and processed, as
   usual, through the Campus Registrar. Please contact that department for
   registration queries.
   a) Registration:
        Generally, Preceptorships should be registered for in the following sequence:

      Preceptorship I: Fall quarter of 4th year on 4 year track, 5th year on 5 year (1
      credit) track.
      Preceptorship II: winter quarter of 4th year on 4 year track, 5th year on 5 year
      (1 credit)
      Preceptorship IIII: Spring quarter of 4th year track, 5th year on 5 (1 credit
      year track
   b) Registration is done on campus, not at the clinic.
   c) All completed Preceptorship documentation and grades will be forwarded to
      the Clinic registration staff for placement in your student file. Until the
      completion of your clinical training, an “IP” grade will appear on your
      transcript for Preceptorships.

5. For Advanced Preceptorships contact the CMD, Dr. Lise Alschuler – these are not
   processed through your Placement Coordinator’s office.

6. All completed preceptorship forms and documentation will be processed in your
   Placement Coordinator’s office. A portion of your records will be forwarded to
   the Clinic Registrar to be placed in your student file. A printout of your
   documented hours/patient contacts will be placed in your student box – please
   retain this copy for future reference in working with the Registrar’s office.

7. Terminology to note: The practitioner who agrees to work with you is the
   Preceptor. YOU are “student” or “preceptoree”.

Do remember to acknowledge your preceptor’s support and generosity with a
  token of appreciation!

To set up an appointment or to obtain additional information regarding preceptorship
   sites, preceptor applications, student packets, etc., contact:
Jeanne Kinley Deller, Placement Coordinator
Office of Graduate and Community Medicine,
At the Bastyr Center for Natural Health
Telephone: 206-834-4103 / Email: jdeller@bastyr.edu

                                    Page 39
BASTYR UNIVERSITY

AOM Preceptorship Program

Preceptorships provide students observational experience with established practitioners outside
of the Bastyr Center. AOM preceptorships are not required, however students may opt for 44
hours of preceptoring as a substitute for Clinic Observation Shift IV. Clinical shifts I and II must
be completed prior to beginning a preceptorship for Clinic Shift IV.

Note: Please copy all completed forms (for your personal files) prior to turning original
documentation in to your Preceptor Coordinator.

1.   Establishing Preceptorships:
         A. All preceptors must be PRE-approved, prior to beginning preceptorship, to
             insure credit hours and Bastyr liability coverage. As AOM approved preceptors
             are very limited, please contact the Placement Coordinator’s office for up-to-date
             opportunities. You are always welcome to recruit a new AOM preceptor.
         B. AOM Preceptor Application Forms, for new preceptors, are available in your
             Placement Coordinator’s office. Practitioners must submit a completed
             application, their current license or certification, and their curriculum vitae or
             resume to be approved as an AOM preceptor.
2. AOM Requirements When Opting for Preceptorship:
                          a. If opting to replace a Clinic Observation Shift with a
                              Preceptorship, you are required to log 44 hours of observation
                              time, equal to one credit, with your approved preceptor.
                          b. Student Preceptorship Plan (attached) – needs to be turned in
                              prior to embarking on a preceptorship. This provides your
                              Placement Coordinator valuable information to be placed in
                              your file until remainder of packet is completed and turned in.
                              You do not need confirmation of approval when turning the Plan
                              in. You will, however, be notified if additional data is required.

3. Additional attached forms must be COMPLETED IN FULL, SIGNED, AND TURNED IN to
your Placement Coordinator to receive credit. (No other forms/format accepted!) Please submit
within a month of preceptorship completion for credit.
                     i. Preceptorship Clinical Time Sheet
                    ii. Summary of Patient Contact Hours
                   iii. Preceptor’s Student Evaluation
                   iv. Student’s Evaluation of Preceptor
                    v. Student’s Self-Evaluation

4. All registration for AOM Proctorship Credits will be approved and processed, as usual,
through the Campus Registrar.
        Registration:
        Generally, Preceptorships should be registered for in the following sequence:

            a. Preceptorship I: Fall quarter of 4th year of 4 year track, 5th year on 5 year (1
               credit) track

                                             Page 40
b. Preceptorship II: Winter quarter of 4 th year on 4 year track, 5th year on 5 year (1 credit)
c. Proctorship III: Spring quarter of 4 th year track, 5th year on 5 year (1 credit)
d. Registration is done on campus, not at the clinic
e. All completed Preceptorship documentation and grades will be forwarded to the Clinic
       registration staff for placement in your student file. Until the completion of your
       clinical training, an “IP” grade will appear on your transcript for Preceptorships.
f. For Advanced Preceptorships contact Steve Given, Lac, AOM Clinic Department
   coordinator – these are not processed through your Placement Coordinator’s office.
g. All completed preceptorship forms and documentation will be processed in the
   Placement Coordinator’s office. A portion of your records will be forwarded to the
   Clinic Registrar to be placed in your student file. A printout of your documented
   hours/patient contacts will be placed in your student box – please retain this copy for
   future reference in working with the Registrar’s office.
h. Terminology to note: The practitioner who agrees to work with you is the Preceptor.
   YOU are “student” or “preceptoree”.

     Do remember to acknowledge your preceptor’s support and generosity with a token of
     appreciation!

     To set up an appointment or to obtain additional information regarding preceptorship
     sites, preceptor applications, student packets, etc., contact:
     Jeanne Kinley Deller, Placement Coordinator
     Office of Graduate and Community Medicine
     At the Bastyr Center for Natural Health




                                         Page 41
ND AND AOM ADVANCED PRECEPTORSHIP

1. An ND student may only apply for an advanced preceptorship after the following are
completed:
       a. All 132 hours (3 shifts) of preceptorship must be completed, submitted and
       grade received.
       b. Eleven patient care shifts must be completed with a grade of achieved
       competency in each. (This does not include Physical Medicine.)
       c. Student is in good academic standing.

2. An AOM student may only apply for advanced preceptorship after the following
requirements are completed:
       a. Observation Requirements must be complete.
       b. Eight intern shifts must be completed with a grade of achieved competency in
       each.
       c. Student is in good academic standing.

3. All student requests for advanced preceptorships must be typewritten. AOM students
must submit their request to the AOM CDC. ND students must submit their request to
the ND CDC. The request must include:

       a. A statement as to the reason for the request, number of preceptorship hours
       already completed and number of patient care or intern shifts completed.
       b. The name of the external clinic site and supervising clinician.
       c. The number of hours to be completed (44 hours is equivalent to 1 shift, 88
       hours are the maximum allowable).
       d. Each advanced preceptorship must be requested independently.
       e . A letter from the supervising physician or acupuncturist of the advanced
       preceptorship must also be submitted with the request. This letter must outline
       the student’s activity, a description of the nature and extent of the student’s
       hands-on-experience, an estimate of the number of patients, a description of the
       active case management on the part of the student, and a description of the nature
       of the active supervision by the preceptor. All of the elements are required for
       advanced preceptorship approval. If the advanced preceptorship supervisor is not
       already an approved preceptor site, please contact the Preceptor Coordinator for
       application materials.

4. The respective Clinic Department Coordinator will present the student’s request to the
clinic faculty for consideration of approval through voicemail or at the next scheduled
Clinical Faculty meeting. The clinic faculty will determine the student’s eligibility for
the advanced preceptorship.

5. If the request is approved, an approval letter will be sent by the Clinic Department
Coordinator to the Clinic registration staff. The Student will be notified in writing of
approval and advised of required paper work. The student will then meet with the Clinic
Registration staff to fill out the required paperwork.

                                        Page 42
6. The total number of advanced preceptorships a student can apply for is 2 (88 hrs). All
external clinic shifts must be registered and paid for as a general patient care shift (2
credits).

7. Students must keep careful records of the patient contacts during an external clinic
shift. The Summary of Patient Contacts Form must be used for this purpose, as well as a
time sheet signed by the supervisor. The number of patient contacts that are counted will
depend on the type of experience you have. This will be reviewed and determined by the
Clinic Department Coordinator.

8. After completing the advanced preceptorship, the completed paperwork should be
turned in to the Clinic registration staff for evaluation and determination of the number of
patient contacts. The Clinic registration staff will then forward the paper work to the
Clinic Department Coordinator for a final grade to be assigned. This grade will be sent
back to the registrar. The student must also give notice of completion of the experience
to the Preceptor Coordinator so that she may send a thank-you note to the advanced
preceptor supervisor.




                                         Page 43
CLINIC OUTREACH GUIDELINES


A good education for health care practitioners includes learning how to market a newly
established practice by taking advantage of promotional opportunities in the community.

To help you learn these skills, Bastyr has built into its academic requirements for the ND,
AOM, and dual ND/AOM programs clinic outreach hours that are to be spent in
promoting the Bastyr Center for Natural Health as well as Bastyr's overall philosophy of
holistic health. The earning of clinic outreach hours can begin for ND and ND/AOM
students after they have completed their clinic prerequisites and have begun their
shifts as observers or secondaries. AOM students are eligible for clinic outreach
hours after they have taken and passed their clinic entrance exam.

The clinic outreach program not only brings into the health center more patients for
student clinicians to work with, but it’s an opportunity for you, the student, to network
with key people in the community and to learn what works and what doesn’t in
promoting a practice. For most of you, the majority of your clinic outreach hours will
likely be spent staffing Bastyr’s health center booth at events around Seattle. This usually
involves conducting free blood pressure checks, distributing health center promotional
materials, answering questions about complementary and alternative medicine, and
networking with other vendors. There are other opportunities for clinic outreach, and they
are discussed below.

 NOTE: Do not confuse clinic outreach hours with the community service hours
 recommended by the Dean of Student’s Office. Clinic outreach is required for
 graduation. Community service is not.


CLINIC OUTREACH REQUIREMENTS
Clinic outreach hours must be completed (and the appropriate documentation submitted)
within the specified timeframe.

The following are the clinic outreach requirements for ND and dual ND/AOM
students:
  -- Hours: 20 total
  -- At least 5 hours must be completed by the end of Winter Quarter of the first year in
 clinic.
  -- At least 10 hours must be completed by the end of Summer Quarter of the second
 year in clinic.
  -- At least 15 hours must be completed by the end of Winter Quarter of the second year
 in clinic.
  -- Any remaining hours must be completed by mid-Spring Quarter of the second year in
 clinic.



                                         Page 44
The following are the clinic outreach requirements for AOM students:
 -- Hours: 16 total
 -- At least 4 hours must be completed by the end of Winter Quarter of the first year in
clinic.
 -- At least 8 hours must be completed by the end of Summer Quarter of the second year
in clinic.
   -- At least 12 hours must be completed by the end of Winter Quarter of the second year
  in clinic.
   -- Any remaining hours must be completed by mid-Spring Quarter of the second year in
  clinic.


 HOW IT WORKS
 Students may begin earning their clinic outreach hours after they have begun their clinic
 shifts.

 Opportunities for clinic outreach are posted on the Clinic board outside the Registrar’s
 Office (2nd floor, campus) and also in the student lounge of the health center.
 Announcements are also made in The Pulse. Because some events fill up quickly and
 others are added at the last minute, please contact the Outreach Coordinator for the most
 up-to-date schedule of events (room 112 on campus, phone 425-602-3352).

 Within two weeks after each event, each participating student is required to record his
 or her hours on a Clinic Outreach Form and have it initialed by the Outreach
 Coordinator. The Clinic Outreach Forms are available from the Outreach Coordinator
 (room 112, campus), the Clinic Registrar (room 249, campus), or the Clinic Marketing
 Manager (3rd floor, health center). The student is then responsible for taking the form to
 the Registrar’s Office where it will be recorded and where a running total of clinic
 outreach hours will be kept. Questions about your total hours should be addressed to the
 Clinic Registrar (phone: 425-602-3404).


 PROPOSING CLINIC OUTREACH EVENTS
 Students and faculty/staff are welcome to propose clinic outreach events; however, each
 proposed event must be approved by the Outreach Coordinator before it can be
 considered an official clinic outreach activity. In other words, no official approval
 means no clinic outreach hours can be earned. Event Proposal Forms are available
 from the Outreach Coordinator (room 112, campus), the Clinic Registrar (room 249,
 campus), or the Clinic Marketing Manager (3rd floor, health center).

 Proposed outreach activities might include participating in community fairs and
 festivals, identifying clinic outreach opportunities at charity/social service events,
 updating clinic informational and promotional materials (under the supervision of a
 resident), public presentations (with the assistance of resident or faculty staff), etc.



                                          Page 45
There are some activities proposed by students and/or faculty which are rather limited in
the marketing skills they teach or the clinic promotion they provide. In these cases,
Bastyr may approve the event but limit the amount of clinic outreach hours that can be
earned. Limitations on hours earned are determined on a case-by-case basis.

Remember, to be considered a clinic outreach event, all activities must meet three
primary requirements:
      1) They must provide the student with the opportunity to develop
communication, public relations and/or marketing skills which can later be
applied to their own practice after graduation.
      2) All events must promote the Bastyr Center for Natural Health, supporting
the securing of additional patients for the clinic. More patients in the clinic means
more patients for student clinicians to work with.
      3) All events must be approved beforehand by the Outreach Coordinator.

Note that, under these new guidelines, some clinic outreach events that
were approved in the past may not be approved now.


TIME EARNED FOR TRAVEL AND/OR PREPARATION
You may include in your total clinic outreach hours the time it took to drive to the
outreach event, up to 30 minutes each way. In other words, no more than 1 hour per
event can be added as travel time. Exceptions will be considered for events outside the
greater Seattle area.

If you have received approval from the Outreach Coordinator to make a
presentation/give a lecture, you can include in your total hours the time you spent in
preparation, up to two hours of preparation time for each hour of presentation.



CONTACT INFORMATION
 -- Outreach Coordinator (approves clinic outreach events, schedules staffing of clinic
outreach events, signs off on clinic outreach forms): Sharon Petersen (425) 602-3352,
room 112, campus. speterse@bastyr.edu

 -- Clinic Registrar (receives approved clinic outreach forms, tracks clinic outreach
hours, answers questions regarding clinic outreach academic requirements): Kurt
Angersbach (425) 602-3404, room 249, campus. kangersb@bastyr.edu

 -- Clinic Marketing Manager (manages all marketing and promotion of the health
center, including the making of clinic outreach policy): Laura Biggers (206) 834-4117,
3rd floor, clinic. lbiggers@bastyr.edu




                                        Page 46
AOM PROGRAM CHINA EXTERNSHIP

If applying, please complete the application that follows, and return to the AOM Program
Chair.
A. Requirements
     You must be in good academic standing, GPA of 3.0 or higher
     Third year status, after 8 internship shifts of experience
     All Bastyr University fees paid to date
     Approved by AOM Department/Chair
     Completion of the AOM Program China Externship Application form, Appendix
        2

B. FINANCIAL PROJECTIONS- see department for current price estimates
Bastyr clinic credit, per credit – 50% clinic tuition credit

C. CREDIT/PATIENT CONTACT SPECIFICATIONS
    Students may apply for up to 8 Bastyr Intern Credits.
    Similar to preceptorship, credits are figured as 1 credit per 44 hours; as such, 1
     full time week of China Clinics averages about 44 hours.
    Only patient contacts that involve diagnosis and treatment of sufficient length
     under proper supervision may be considered for credit.
    Documentation of all contacts considered for credit must be presented to the
     Clinic Registrar upon return, for review and approval.

D. EVALUATION/DOCUMENTATION
    Students must keep documentation on all contacts to be considered for credit. In
     addition, all clinic hours must be kept and signed off with patient contacts by the
     supervising acupuncturist.
    An evaluation form will be sent to each site for completion by each supervisor.
     Students must complete an evaluation form for each major supervisor at each
     China site.
    All documents must be turned in to the AOM Department Chair upon return and a
     grading interview will be scheduled as well.

E. APPROVED SITES FOR CHINA

Chengdu: Chengdu University of TCM
Shanghai: University of TCM




                                        Page 47
STUDENT ACADEMIC ADVISING: ND AND AOM

1. The following is required for student advising with a Clinical Faculty advisor:
    a. Each student clinician is required to meet with her/his Clinical Faculty advisor 1
        time/year for each year they are enrolled in the clinic. Students are encouraged to
        meet with their advisor as often as needed.
    b. Each student clinician will be assigned to a Clinical Faculty advisor. If for any
        reason that assignment needs to be changed, please see the main campus
        registrar’s office.
    c. AOM students may still be assigned a campus advisor during their 2nd year.
    d. There is a one-page advising form that the student should fill out and bring to the
        advising session. The advisor will write her/his comments on the form, sign and
        date it. The student is responsible for providing a copy to the clinic registration
        staff.
    e. It is the student’s responsibility to contact her/his advisor and make an
        appointment.
    f. The advising sessions are a time for students to share any concerns, problems,
        complaints, suggestions or issues that are important to her/him. Advisors are to
        review a student’s academic program and keep them on track with their
        course/clinical requirements.
    g. If a student fails to meet her/his requirement of 1 advising session/year,
        prohibition of enrollment in following quarter shifts or, if graduating, failure to
        graduate until the advising sessions are completed will occur. (A clinic year is
        from the beginning of Summer Quarter to the end of Spring Quarter, so a
        determination for advising will be made for the year at the end of Spring Quarter.)

2. At least 1 advising session is required with the Clinic Registration staff before
graduation.
    a. It is recommended that students meet with the Clinic Registration staff near the
        beginning of their clinical experience in order to clarify and understand the clinic
        education requirements, and how their progress is tracked each quarter.
    b. Each quarter the Clinic Registration office will provide to each student a
        summary of her/his completed requirements.
    c. Additional advising sessions are recommended in order to stay current with
        completed and remaining outstanding requirements.
    d. It is required for graduating students to meet with the Clinic registration staff in
        their last quarter in order to be on-track to graduate.

3. The acupuncture Intern B (AIB) must meet with the AOM Clinic Program Coordinator
or faculty designee, upon completion of all Clinical Competency Two Objectives to
determine advancement to Acupuncture Intern A (AIA). These competencies include the
AIB performing a minimum of 20 first patient interactions (FPI) and 80 subsequent
patient interactions, (SPI) over a minimum of 3 academic quarters and 5 clinic shifts.

4. There is no advising requirement for Nutrition students.


                                         Page 48
STUDENT REGISTRATION FOR CLINIC SHIFTS

  1) The clinic registration staff coordinates registration for clinic shifts. The clinic
     registration staff is implementing a year-long annual registration for clinic shifts.
     This will begin as soon as possible.

  2) Registration for each quarter will take place approximately 6 to 7 weeks prior to
     the start of the following quarter. This timing was chosen so as to avoid midterms
     and still allow enough time for patient scheduling for the subsequent quarters.

  3) The class schedule for the following quarter will be published before clinic
     registration occurs. Classroom and clinic schedules are coordinated to eliminate
     conflicts, as much as possible, and provide adequate opportunity for clinicians
     stay on track for graduation. Shift assignment is performed using information
     from each students completed academic registration for required classes. A
     student clinician-planning guide will be used to record the progress of individual
     clinicians.

  4) ND REGISTRATION: The goal is to have a primary and secondary student
     clinician in each room in general patient care, homeopathy and counseling, and to
     have 3-4 primary and 3-4 secondary student clinicians on each physical medicine
     shift. There will be co-primary clinicians in most rooms as the clinic intensive
     model of training is implemented. There may be occasions when there will be
     three student clinicians assigned to each patient care room as a health care team,
     normally consisting of one primary and two secondary clinicians. *Co-primary
     designation does not imply that both clinicians function in the role of primary for
     each patient. Students may not ever share primary patient contacts or both act as
     primary for the same patients. Co-primaries alternate being in the role or primary
     and secondary.

  5) Each ND student will be given a year-long schedule of the number and type of
     shifts that they will be required to complete each quarter. Please refer to the
     student clinician-planning guide for details.

  6) The available days and times for clinic shifts will be determined by the ND
     student’s academic track.

  7) Each quarter, ND students will have a 1-week period during which time they may
     switch tracks with another student, should such changes be necessary. Requests
     to trade academic tracks must be submitted for approval to the clinic registration
     staff on the quarterly track trade form, and requires the signatures of both student
     clinicians. Any track changes will remain in effect for the remainder of the
     academic year.




                                        Page 49
8) AOM REGISTRATION: The goal is to have an AIA (primary) and an AIB
   (observation) in each room in acupuncture patient care. There may be occasions
   when there will be three student clinicians assigned to each acupuncture patient
   care room as a health care team, normally consisting of one primary and two
   secondary clinicians. When there are two interns in one room, both must place
   and remove needles during a patient treatment in order to receive credit for the
   patient contact. Under no circumstances may Intern patient contacts by shared
   when only one Intern was physically performing the treatment.

9) NUTRITION REGISTRATION: The goal is to have a primary and two secondary
   clinicians (one secondary typically observes from the observation office) assigned
   to each room in nutrition patient care. The student roles will rotate throughout the
   shift.

10) REGISTRATION All Programs: Student clinician pairings are subject to the
    final approval of the Medical Director/Clinic Program Coordinators.

11) After viewing the faculty schedule, all students will submit to the clinic
    registration staff, by the stated deadline, their requests for the supervisors and
    times of their assigned shifts for the upcoming quarter. These requests must be
    during the days assigned to the students based upon their assigned academic track
    and course schedule.

12) The clinic registration staff will attempt to meet the student’s requests when
    scheduling each student their required shifts; however, this is not guaranteed.

13) Once the schedule is completed by the clinic registration staff and approved by
    the clinic medical director, it is final and entered into the patient scheduling
    books.

14) The clinic medical director may make changes to the student clinic schedule at
    any time.

15) In general, each ND and AOM student will be registered for a minimum of two
    shifts, and a maximum of four shifts per quarter. Each ND student will be
    registered for at least one patient care shift per quarter. The required shifts for
    ND students may change as the Clinic Intensive program is fully implemented.

16) Each Nutrition student must be registered for at least one nutrition shift per
    quarter, but no more than two shifts per quarter without the approval of the
    Nutrition clinic program coordinator.

17) No student in any program may do more than two shifts per day. Shift times may
    not overlap with other shifts or courses and an adequate amount of time must be
    maintained for travel between the clinic, campus, and external site locations.


                                      Page 50
18) It is important to note that the assigned academic track for ND students and
    assigned clinic shifts for all students are not amenable to changes necessitated by
    other considerations such as outside employment schedules, childcare schedules,
    etc. It is, therefore incumbent upon every student to make whatever arrangements
    are necessary in order to accommodate his or her assigned academic and clinic
    schedules.

19) A student may only withdraw from the clinic if they have a verifiable emergency.
    They must obtain a letter signed by the clinic medical director approving this
    withdrawal.

20) Interim clinic registration information: refer to section on Interim Clinic.

21) In order to register for clinic shifts, students must first register with the academic
    registration staff.

22) Students may register for clinic elective shifts including observation shifts in the
    other programs on a space available basis.




                                      Page 51
INCLEMENT WEATHER POLICY

This is a reminder of Center policy and procedure regarding inclement weather.

     1.      In the event of severe inclement weather conditions, the Executive Vice
             President and the Dean of Clinical Affairs will together determine Center
             closure. Only in the event of extremely severe weather conditions will such
             closure occur, and every effort will be made to keep the Center open, as it is a
             health care facility including urgent care.

     2.      If a decision is made to close, the following will be in effect:

      a.      If a decision to close is made before regular Center business hours, it will be
              broadcast on local radio and television news broadcasts beginning at 7 AM, the
              Center main voice mail message will be updated by 6 AM, and several staff
              members will come in to call and inform patients of Center closure and post
              signs on Center doors.
      b.      If a decision to close is made during business hours, signs will be posted
              immediately on Center doors, the master voice mail message will be modified
              immediately, patients will be called and informed of closure, and the
              University will be called to post signs for students.
      c.      If a decision is made to close on a Saturday, the Center’s main voice mail
              message will be updated up 6 AM. Jane Guiltinan will notify David
              VanHollebeke, Saturday Center Supervisor and staff members will come in to
              call and inform patients of the Center’s closure and post signs on Center doors.

3.        If there is a power and/or phone outage, communications with employees, patients,
          and students will be limited. Center staff will do their best to post signs and have
          someone at the Center to deal with anyone who comes in.

4.        Jennifer Mulford, Operations Manager, and Steevie Bereiter, Assistant to the
          Center Operations Manager, are trained on how to change the voice mail message.

5.        Jane Guiltinan is the primary decision-maker for the Center. Lise Alschuler and
          Lisa Hopkins are secondary decision-makers for the Center in case there is lack of
          clarity over what we will do. If none of those people are reachable, Lynne
          McCutchen has been vested with the authority to make the decision.




                                              Page 52
CLINIC ATTENDANCE POLICY

All Clinical Faculty will take attendance, both at case preview and case review.

   1) It is the responsibility of the Clinic Medical Director, the program CPC’s, and the
      Assistant Patient Services Manager to make changes in the scheduling of student
      clinician shifts. Students cannot mark themselves in or out in the patient schedule
      book at the front desk. Students must fill out an Absence/Substitute Form –
      Student Clinician, (see Appendix 3 for a copy of this form), have it signed by
      the supervising Clinical Faculty from whose shift the student will be absent, and
      turn it in to the Clinic Program Coordinator prior to the shift, except in case of
      emergency. It is the student’s responsibility to be certain to include the name of
      another student who will cover the shift in their absence. Unapproved changes in
      the schedule book will result in loss of clinic hours. Please note: The term shift
      may refer to either the QUARTERLY shift, which is a 4-hour block (daily shift)
      that meets weekly for the 11 weeks of a quarter, or may refer to the shift of 4-
      hours that occurs on a particular day.

   2) All student clinicians will be required to attend at least 80% of each assigned
      quarterly shift, including clinic assistant, observation, intern and patient care
      shifts, in order to receive a grade of achieved competency for the quarterly shift.
      Holidays and emergency closures do not count against the total quarter’s
      attendance, but the missed hours must still be made up. A student must
      attend at least 9 daily shifts for each quarterly shift in order to obtain a grade for
      that shift. A student who does not attend at least 80% of the quarterly shift (2
      excused absences) will normally receive a failure for that quarterly shift, lose all
      hours and patient contacts, and the entire quarterly shift would need to be taken
      again. Exceptional circumstances resulting in a third absence may be approved at
      the discretion of the supervisor. Four or more absences will result in an automatic
      failure for the shift. Please note that 100% of your required clinical hours must
      be completed before recommendation for graduation.

   3) An unexcused absence is defined as not being at a scheduled shift, and failing to
      notify the scheduled supervising clinical faculty member of your absence prior to
      the start of the shift. The first unexcused absence during a term will result in the
      student clinician being required to complete three makeup shifts (12 hours). A
      second unexcused absence will result in a grade of “F” for the shift and the loss of
      the entire shift’s hours and patient contacts. The supervising clinical faculty
      member may, at their discretion, accept notification of an absence after the start of
      the clinic shift in the event of an extraordinary emergency. Even if the student
      calls the supervising clinical faculty member prior to the missed shift, the
      supervisor reserves the right to define the missed shift as unexcused absence and
      then sanction the student as described above. This would occur if, in the
      estimation of the supervisor, the reason for the student’s absence does not warrant
      missing the shift.

                                        Page 53
4) Incomplete grades can only be given in case of illness and personal emergency.
   Students must request an Incomplete grade and receive the approval of their
   supervisor. It is up to the discretion of each supervising Clinical Faculty member
   whether or not to grant an incomplete grade.

5) In cases of emergency, every effort should be made to contact the Clinic Program
   Coordinator and supervising Clinical Faculty. The clinic has 24-hour/day
   coverage for messages, so if a student contacts the clinic off-hours, they should
   leave a message at the Clinic Program Coordinator’s voice mail extension (206-
   834-4106). The student should contact the front desk only to have their
   call/message routed to their supervisor. Once the supervisor has “approved” the
   absence, the supervisor will notify the front desk staff about the absence. On
   Saturdays and evenings, the student should leave a message with the Clinic
   Program Coordinator and contact their supervisor. Upon returning, the student
   should contact the Clinic Program Coordinator.

6) If a student knows she/he will not be able to come to her/his scheduled shift
   during the first week of a quarter because of being out of town or other unusual
   circumstances, they must fill out an absence/sub form and contact the Clinic
   Assistant prior to the date of absence. A student will automatically be given a
   grade of failure and dropped from the shift if no arrangements are made with the
   Clinic Program Coordinator by the second week of the quarter.

7) Midwifery students must have a backup substitution available on an “immediate
   notice” basis for all shifts missed due to their attendance at a birth.

8) Standard policy on attendance, evaluation of students and instructors, professional
   behavior, and discipline will apply at all Bastyr external sites. Instructors and
   students will be issued the usual forms for documenting these processes.
   Instructors at external sites are aware of internal clinic shift procedures such as
   case preview/review and documentation guidelines, and are encouraged to model
   these procedures as feasible. The instructor may develop special procedures that
   pertain to the needs of the site. Registration for all external sites is done through
   the registrar at the usual time and may, at the instructor’s request, include an extra
   screening process.




                                     Page 54
ABSENCE AND SUBSTITUTION

  1) It is the responsibility of every student clinician to inform both their assigned
     supervisor and the Clinic Program Coordinator of any absence from the clinic,
     prior to that absence.

  2) Please comply with the following procedures (a sample form is included for your
     familiarity):

  3) Fill out the bottom portion of the form (fill out a separate form for each shift you
     will miss).

  4) Notify the supervisor of each shift that you will miss and have her/him sign the
     appropriate space below.

  5) Turn this form in to the Clinic Program Coordinator for approval.

  6) Primary student ND clinicians and AOM interns must obtain a substitute. It is the
     responsibility of the student to contact their patients who are coming in
     specifically to see them, and ask the patients to contact the front desk if they wish
     to reschedule. Patient phone numbers can be retrieved from the front desk. Also,
     notify the secondary student clinician or observer clinician that you will not be on
     shift.

  7) Secondary student clinicians must also obtain a substitute. In addition, they must
     notify the primary student clinician that they will not be on shift.

  8) Please do all of these in advance of the shift(s) you will be absent.

  9) If ill or in an emergency situation, call in to your supervisor and to the Clinic
     Program Coordinator (206-834-4106) prior to the start of shift. Call the main
     clinic number: 206-834-4100. Ask to have your supervisor paged. If they are
     unavailable, leave a message in their voicemail. Primary student clinicians must
     speak with the supervising Clinical Faculty to make decisions regarding patients
     scheduled for the day of absence.

  10) The Clinic Program Coordinator will notify the front desk staff, who in turn will
      make the changes in the schedule book. Students should not write in or make
      changes in the schedule book.

  11) Failure to follow this procedure will result in loss of clinic credit, hours and/or
      patient contacts.

  12) Student who are more than 30 minutes late to their assigned shift will receive a
      written warning for a 1st event and need to make up missed time. Students will

                                        Page 55
         receive a clinic sanction for a 2nd event in the same quarter. (See section
         regarding sanctions, page 55.

      13) Students who are absent more than 2 days, or 3 days with the supervisor’s pre-
          approval, on any one shift during a quarter (holidays excluded) will:

             a. Lose all clinic credits/hours/patient contacts for the entire quarter shift
                involved, and receive a grade of F.
             b. The quarterly shift will need to be taken again in its entirety.

SUBSTITUTE/EXTRA HOURS
 1. Students receive full credit for all hours that they substitute for other students or
    come in on a float room basis, which must be pre-approved by the supervising
    Clinical Faculty and scheduled, if available. Float rooms are on a space-available
    basis. Any patient scheduled in float room must be pre-approved by the supervisor
    for that shift. There cannot be more than 2 float room patients during any given
    shift. Once written and signed approval from the supervisor is granted, the student
    must present this note to the Assistant Patient Services Manager before the float
    patient can be scheduled.

 2.     These substitute/extra hours can be used to make up shift hour deficits.

 3.     Students should record the substitute/extra time on the reverse side of the Time
        Sheet under the section for Substitute/Extra hours. No more than 4 hours can be
        recorded for any 1 shift.

 4.     The supervising Clinical Faculty on shift must sign off the hours that day.

 5.     All patients seen during the substitute/extra hours count towards the total patient
        contact requirement for ND students of 350 patients. All patients seen while
        substituting count towards the total patient contact requirement for AOM students
        of 400 patients. These patient contacts need to be recorded on the Summary of
        Patient Contacts Form.

 6.     Hours that accumulate in the Substitute/Extra “bank” cannot be used to construct a
        shift. These hours can only be used to make-up shift hour deficits, or can be stored
        for future needs.

 7.     Sub and Extra hours are automatically shifted into areas showing a deficit of hours
        by the office of the Clinic registration staff, when the quarterly update is done. ND
        students should specify if the sub and extra hours are for patient care or clinic
        assistant.

 8.     Students may use Interim shift hours to make up missed shifts during the preceding
        quarter(s). To do so, those hours must be recorded on the Time Sheet on the
        reverse side, in the SUB hours section, not on the Interim Sheet.

                                           Page 56
SANCTIONS

   1) If a student does not adequately perform one or more of any of the critical shift
      competencies on any given day, or does not achieve competency on any two or
      more of the non-critical competencies, the supervisor has the right to issue a
      sanction to the student. This sanction will normally be preceded with a written
      warning to the student by the supervisor. A second similar poor performance will
      result in a written sanction. A sanction results in the loss of all of the daily shift
      hours and patient contacts for the shift under review.

   2) Two sanctions on the same shift will automatically result in failure grade for that
      entire shift with the loss of all patient contacts and hours obtained on that shift.

   3) A student will be issued a sanction when found to violate any of the policies of
      the clinic, namely, but not exclusively:

           a.    breaching patient confidentiality

           b.    removing any patient-identifying information from the clinic

           c.    acting in an unprofessional or disrespectful manner at any time,
                 including off-shift

   4) The severity of the sanction will depend on the severity of the offense and may
      range from loss of 4 hours and patient contacts from one of the student’s shifts to
      suspension from the clinic. The involved supervisor and the Clinic Medical
      Director will determine the type of sanction. (See further sections for more
      details.)

   5) Sanctions are not grades and therefore are not subject to appeal under the appeal
      of grade policy. A student may issue a grievance according to the grievance
      procedure as outlined in the student handbook.


LOSS OF CREDIT, SUSPENSION, DISMISSAL

There are specific actions and behaviors that can result in partial loss of credit, failure (F)
for an entire shift, suspension and/or dismissal from the clinic.

   1) Clinic sanctions result from violation of clinic policy or procedure as determined
      by the student’s clinic supervisor or any other clinic supervisor if the event occurs
      outside of a shift or off-site. A supervisor may choose to issue a warning to the
      student in lieu of a sanction, but upon repeated violation, a sanction will be
      issued. A Clinic Sanction results in the loss of four (4) clinic contact hours, and
      all patient contacts received during those hours. The hours and contacts must be
      made up. A written notification of clinic sanction must be given to the student by

                                          Page 57
        the clinic supervisor, with a copy to the clinic Medical Director and the Clinic
        registration staff for the student’s file. If a student receives two (2) clinic
        sanctions on one clinic shift, this will result in a failure (F) grade for that entire
        quarterly shift. The shift will need to be repeated in its entirety. No credits,
        hours, or patient contacts will be given for the failed shift.

   2) The following violations may result in a clinic sanction:

   a. Failure to follow the clinic absence/substitution policy. (Except for
      UNEXCUSED ABSENCES- Please refer to the Absence and Substitution section
      in this handbook).
   b. Failure to follow the clinic protocols, policies and procedures as described in the
      Student Clinician Handbook.
   c. Failure to follow the instructions or recommendations of the supervising
      doctor/physician.
   d. Causing intentional harm to a clinic patient, neglect of a patient’s care and safety
      or any form of verbal abuse.
   e. Inappropriate behavior or unethical conduct with Clinical Faculty, staff, patients
      or students.
   f. Failure to follow the phone contact policies and procedures.
   g. Failure to follow Clinic Handbook charting policies and procedures.

The following violations will result in loss of clinic credit, suspension, and/or dismissal,
depending on the circumstances and severity of the violation. In the case where
suspension or dismissal may be appropriate, the Clinic Medical Director will make a
recommendation to the Academic Vice President according to the circumstances of each
incident:

   a.   Dishonest conduct.
   b.   Practicing medicine without a license.
   c.   Violation of the NHC Code of Ethics.
   d.   Breach of patient confidentiality (which includes the removal of any identifying
        patient material from the clinic).

Failure to convert an Incomplete or Partial Competency for a clinic shift to Achieved
Competency within 1 quarter will result in:
    a. A Failure for the shift in question, with loss of all hours and patient contacts. The
        shift will need to be repeated in its entirety.
    b. It is the student’s responsibility to complete the requirements, and take care of the
        paper work. Contact the Clinic Registration Staff.

Please note: This is not subject to the grade appeal process. If a student has a concern,
please refer to the grievance policy.




                                           Page 58
CLINIC GRIEVANCE POLICY FOR STUDENTS

This policy is designed to establish a method whereby students, Clinical Faculty,
residents and other staff can voice their concerns and feelings about policies, procedures
or other concerns in a way that they will be heard, and the concern can be dealt with in a
fair manner.

   1. If a student has a concern about something that happens while on a patient care
      shift, they should first discuss the matter in private with the supervising Clinical
      Faculty. If it is not resolved, the student must meet with their advisor. If it is still
      not resolved, then they should type a letter about the issue to the Clinic Medical
      Director and set up a meeting to discuss it with the Medical Director.

   2. If a student has a concern about something that happens while on a clinic assistant
      rotation in the lab, they should first discuss the matter in private with the
      supervisor. If it is not resolved, they must meet with their advisor. If still not
      resolved, then they should type a letter about it to the Clinic Medical Director.

   3. If a student has a concern about something that happens while on an external
      clinic shift or preceptorship, they should first discuss the matter in private with
      the supervisor. If it is not resolved, they must meet with their advisor. If still not
      resolved, then they should type a letter about it to the Medical Director and set up
      a meeting to discuss it with the Medical Director.

   4. If a student has a concern about a policy or procedures, or clinic operations in
      general, please type a letter about it to the appropriate Clinic Department
      Coordinator and set up an appointment to discuss it with the Clinic Department
      Coordinator. If still not resolved, then they should forward their letter along with
      an explanation from the CDC to the Medical Director and set up a meeting to
      discuss it with the Medical Director.

   5. If a student has a concern about hours, number of shifts, credits, registration,
      clinic grades or attendance, please see the clinic registration staff.

   6. If a student has a concern about the preceptor program, this should be addressed
      to the Preceptor Coordinator.

   7. If any issue or concern cannot be satisfactorily resolved by a meeting with the
      Clinic Department Coordinator, Preceptor Coordinator and/or clinic registration
      staff, then the original letter and subsequent written reviews of the issue from the
      Clinic Department Coordinator, Preceptor Coordinator and/or Clinic registration
      staff will go to the Clinic Medical Director.

   8. If the issue cannot be satisfactorily resolved by the Clinic Medical Director, all
      written materials along with a written letter from the Medical Director will go to
      the Dean of Clinical Affairs for review.

                                         Page 59
  9. If any issue or concern cannot be satisfactorily resolved by a meeting with the
     Dean of Clinical Affairs, then the issue and all accompanying materials will go to
     the Vice President of Academics.

  10. If any issue or concern cannot be satisfactorily resolved by a meeting with the
      Dean of Clinical Affairs, then the issue and all accompanying materials will go to
      the Executive Vice President for final guidance and resolution.



CLINIC GRIEVANCE POLICY for PATIENTS

  1. In the event that a patient has a grievance, s/he is directed either by the
     supervising doctor in attendance or by the student clinician to fill out a comment
     form located in the patient waiting area. The forms are clearly labeled and
     displayed. The completed form is then routed to either the Clinic Administrator,
     if the comment is business related, or to the Medical Director, if the comment is
     related to health care services. The matter is then addressed by one of these two
     individuals or delegated out to a third party. Once the patient’s concern is
     addressed, s/he is notified in writing of the outcome.

  2. In addition to the patient filling out comment forms, many minor grievances are
     handled by the patient service department of the clinic and the front desk staff.
     Upon a patient’s first visit to the Bastyr Center for Natural Health, patient
     services provides the patient with a two-sided New Patient Information handout.
     On this handout is a list of Patient Rights and Responsibilities. One of the rights
     and responsibilities listed on this handout is that “patients have the right to bring
     questions, concerns, complaints or compliments about any aspect of one’s care or
     service to the individual provider, their health plan, or provider network”.
     Therefore, the patient is informed in writing of the right to bring forth any
     grievances that may arise.

  Please refer to the Student Handbook for other information regarding grievances,
  sanction and appeals policies.

PERFORMANCE EVALUATIONS

  1. In order to enter the clinical training program, students (including Advanced
     Standing/Transfer students) are required to receive an AC in all clinic entry
     courses. Taking and passing a clinic entrance exam is required to receive an AC
     in Clinic Entry I (AOM/Nutrition) and Clinic Entry II (ND).

  2. Evaluation of performance is an essential part of each student’s training.
     Performance evaluation is done in the following way:


                                       Page 60
a. Each quarter, the supervising doctor/acupuncturist/R.D. Clinical Faculty
   on each shift will evaluate students. This evaluation consists of an
   objective and a subjective section. One of the following grades can be
   given on each shift:
   W – withdraw
   IP – in progress
   F - Failure
   I – Incomplete
   PC – partial competency
   AC – achieved competency

b. Each supervisor may use a daily evaluation checklist that coincides with
   the evaluation form at the end of the quarter. Students can receive daily
   feedback on their performance. Students are encouraged to follow-up
   with supervisors and/or advisors regarding any issues identified on daily
   feedback.

c. If a student is not achieving competency, it is the responsibility of the
   supervisor to notify the student in writing. The deficiencies in
   performance must be clearly and specifically noted and appropriate
   recommendations for correcting the deficiencies must also be given. This
   notification should be given with adequate time left in the quarter for the
   student to correct the deficiencies. In general, notification within the 4th –
   8th week of each quarter will be considered sufficient. A student may still
   receive a failure after the 8th week, without having received prior written
   notification, if the deficiencies of performance or behavior began or are
   identified after the 8th week.




                              Page 61
GRADING

   1. Grading in the clinic is based on an achieved competency system. Each student
      must receive a grade of achieved competency in order to get credit for a shift and
      move on to the next shift.

           a. Clinic, as part of academics, uses the same grading system as established
              for the didactic part of academics. This is a competency based grading
              system.

           b. The achieved competency grading system is not the same as the pass/fail
              grading system. Be certain to understand this difference. Essentially a
              grade of AC means that all clinical skills for each level have been
              successfully mastered, as appropriate to the student’s current status in the
              clinic.

           c. The clinical skills a student must demonstrate mastery of are listed on the
              Primary and Secondary/Observing student evaluation forms, located in the
              Clinical Faculty offices. The Clinical Faculty is responsible for evaluating
              a student for competency on each of the clinical categories on the
              evaluation form. The student’s current status in clinic is taken into
              account when Clinical Faculty are evaluating a student’s competency. The
              level of skills that must be demonstrated to achieve competency
              progressively increases as the student progresses through her/his clinical
              rotation. These increasing performance expectations are generally defined
              in the clinical competency section of the Clinic Handbook. Please note
              that competency based grades are not based on an averaging of clinical
              skills, but rather that each one of the clinical categories has been
              successfully mastered at the appropriate level as assessed by the
              supervising Clinical Faculty. Additionally, there are certain critical
              clinical skills that must be competently demonstrated in order to achieve
              an AC grade. Any one of these critical clinical skills that is not
              demonstrated successfully over the course of the shift as assessed by the
              supervising Clinical Faculty will result in an F grade. PC grades may be
              given if one of the non-critical clinical skills is not demonstrated
              successfully. More than one of the non-critical, yet essential clinical skills
              not competently demonstrated over the course of the shift will result in an
              F grade.

2. In the event of a dually supervised shift, the senior supervising Clinical Faculty
   person on each shift grades students each quarter.

3. Currently, the clinic Clinical Faculty uses a comprehensive evaluation form for each
   department of the clinic. There are a number of criteria that are used to evaluate the
   student’s performance and competency on each clinic shift. Please refer to
   Appendices 4 through 9 for copies of the evaluation forms.

                                         Page 62
       a. Each week the supervising Clinical Faculty will evaluate the students on
          her/his shift. Utilizing the criteria from the performance evaluations, written
          feedback may be given to students on a weekly basis. Students are
          encouraged to follow up regarding the feedback with the supervisor and/or
          advisor.

       b. At the end of the quarter, all this information will be used to fill out the
          quarterly performance evaluation form. This quarterly evaluation also has a
          subjective section to be filled out by the supervising Clinical Faculty.

       c. A student can receive a quarterly grade of:
       W - withdraw
       IP - in progress
       F - failure
       I - incomplete
       PC - partial competency
       AC - achieved competency

4.   Here is a brief summary of what each grade means:

       a. Withdraw: A student officially withdraws by notification to the Clinic
          registration staff, who will then notify the registrar. Withdrawal requests are
          for emergency purposes only and must be done no later than the end of the
          eighth week of the quarter the shift is taken. A letter from the department
          chair explaining the reason and giving approval for the withdrawal is required.
          An approved withdraw allows a student to keep all patient contacts. Hours
          completed to date can be used as sub/extra hours. The only exception to this is
          in the event that prior to a withdraw, the student received a mid-quarter letter
          identifying areas of deficient competency. In this case, all patient contacts
          and hours prior to the withdraw will be forfeited. Note: When a shift is
          officially dropped by a student after the deadline, the result will be a loss of
          all clinic credits/hours/patient contacts for the entire quarter shift involved.

       b. In Progress (IP): A student has Achieved Competency but doesn’t have
          enough patient contacts or hours on a quarterly shift (greater than 80% but
          less than 100% hours but still AC level work). Once 100% of hours and/or
          patient contact requirements are met, the grade will be changed to an AC.

       c. Failure: A student fails to satisfactorily demonstrate competency as
          appropriate for current clinic status for any of the critical clinical categories or
          more than one of the non-critical clinical categories listed on the evaluation
          form. There is a loss of all clinic credits, hours and patient contacts for the
          shift. The shift must be made up in its entirety, in the Bastyr Natural Health
          Clinic. The student will be on Academic Probation. One (1) unexcused
          absence will result in an automatic failure. See absence policy. Two (2)

                                         Page 63
         quarterly shift failures in the same year automatically places the student on
         academic probation. In addition, the clinic medical director, program
         coordinator, and program chair (if applicable) will make a recommendation to
         the EVP regarding possible dismissal from the University. In the event that
         the student is not dismissed, a learning contract will developed for the student.
         They must successfully meet the requirements of the learning contract in order
         to avoid dismissal.

      d. Incomplete: In order to receive an Incomplete (“I”) grade for a clinic shift, a
         student must contact the Clinic registration staff and shift supervisor.
         Students receive an Incomplete only for medical or other verifiable
         emergencies. An Incomplete is given only when the student is doing
         satisfactory work, but cannot complete the requirement because of a serious
         illness or personal emergency. An Incomplete is not given if a student is
         failing a class or clinic shift. All Incomplete grades must be successfully
         completed by the end of the third week of the following quarter, or they will
         convert to an F. Students must provide a doctor’s letter stating that they are
         ill and/or written documentation of personal emergency.

      e. Partial Competency: The critical clinical categories were demonstrated
         successfully; however, one of the non-critical clinical categories was not
         competently demonstrated, appropriate to student’s current clinic status. The
         supervisor who gave the PC will submit written requirements to the student all
         of which the student must satisfactorily complete in order to change the PC to
         an AC. The student must complete the requirements necessary to bring the
         PC grade to an AC grade by the end of the following quarter.

      f. Achieved Competency: The successful demonstration of mastery of all the
         clinical categories listed on the evaluation form, appropriate to the student’s
         current status in the clinic.

 5.   A grade needs to reflect what a student earns for a particular quarter without any
      contingencies. There are to be no contingencies that carry over into the next
      quarter. The student will receive a performance evaluation for her/his
      performance each quarter.

6.    At Mid-Quarter of each quarter there is a Clinical Faculty-grading meeting.

      a. The purpose of this confidential meeting is to go over the objective and
         subjective evaluations of students in order to identify the strengths,
         weaknesses, and areas of concern and recommendations. All of these
         concerns are discussed in order to find ways to appropriately evaluate students
         and to strategize ways to improve the student’s chances of success in their
         clinical training.



                                       Page 64
            b. This information is recorded by the Clinic registration staff and is kept
               confidential in the registrar's office.

            c. Any students who needs follow-up from this meeting will be identified.
               Either their clinic supervisor, their advisor, the Clinic Medical Director or
               clinic registration staff will follow up with the student depending on the issues
               involved. If necessary, the clinic registration staff will give a written
               summary of the comments from the meeting to either the supervisor or the
               advisor. The supervisor or the advisor may set up a meeting with the student
               to discuss the issues and strategies raised.

7.   Students who are at risk for failing the shift must be notified in writing by their
     supervising Clinical Faculty before the end of the quarter, unless this risk is not evident
     until the end of the quarter. A copy of this letter will also be given to the Clinic Medical
     Director, the Program Chair (of the program applicable to the student) and to the clinic
     registrar's office (for student’s clinic file).

        a. A student should be given sufficient notice so that she/he may have time to
           improve in the areas of concern. In general, notification within the 4th to 8th week
           of each quarter will be considered sufficient notice. A student may still receive a
           failure after the 8th week, without having received prior written notification, if the
           deficiencies of performance or behavior began or are identified after the eighth
           week.

        b. The notification letter must identify each area of concern and must give clear
           guidelines as to how the student needs to improve and what is required in order to
           achieve competency.

        c. Students must meet with their supervisor and/or advisor if they receive notice of
           risk of failing a shift. It is solely the student’s responsibility to arrange this
           meeting.

        d. A copy of the notification letter should be given to the Clinic registration staff
        (for student’s clinic file).

     8. Grades are kept in the student’s files in the Clinic registration staff’s office. If a
        student has a question about her/his grades, please make an appointment with the
        clinic registration staff to review the grades. These files are confidential.

     9. If a student wishes to file a grievance or appeal a clinic grade, they must follow the
        University’s academic grievance and appeal of grade procedure as outlined in the
        Student Handbook.

     BCNH Grading Manual (Naturopathic Program)



                                               Page 65
    Grading criteria for primary and secondary clinicians are outlined in this section. It is
important for the supervisor to be aware of the number of shifts completed by the student
at the beginning of each quarter. A list of shifts completed and attendance records are
supplied by the clinic registrar. Please note this number on your attendance sheet. For
our purposes, an early primary is a clinician who has been primary for 0-2 quarters,
usually corresponding to patient care shifts 5-8. A mid-primary clinician is working on
patient care shifts 9-12 and a late primary is working on shifts 13-17. Naturally, an early
primary clinician will demonstrate less skill in all areas than a late primary, and the
grading system must take this into account.

Secondary clinicians can also be thought of as early secondary and late secondary
clinicians. The supervisor’s evaluation should reflect where a student is along this
spectrum. Increasing expectations of advancing clinicians are appropriate. A PC in any
area of skill on the final grade implies that the student has been made aware of the
deficiency in writing during the quarter and was unable to improve sufficiently to warrant
an AC grade. It is the supervisor’s responsibility to communicate to the student clearly
and in writing when a PC is pending, and to note how the skill may be improved. If a
student is failing a specific category, a warning letter is necessary to advise the student.
See part one, Mid-quarter or warning letter, page 18-19.

Section A – Primary Clinicians

      1.    Initiative and responsibility in patient care
      2.    Communication skills and rapport with patients
      3.    Interviewing skills
      4.    Physical exam skills
      5.    Overall case management skills
      6.    Charting technique (Completeness and clarity)
      7.    Application of academic learning to clinical training
      8.    Differential diagnosis / assessment skills
      9.    Knowledge of Naturopathic therapeutics and their proper application
      10.   Patient follow-up care
      11.   Listening skills
      12.   Time management skills
      13.   Cooperation with clinic supervisors and staff
      14.   Communication skills with peers and supervising doctors
      15.   Motivation and initiative in learning clinical skills
      16.   Familiarity with clinic policies and procedures and efficiency in following
            them




                                          Page 66
1. Initiative and responsibility in Patient Care

Skills that must be demonstrated in this category to receive an AC:
The student demonstrates overall initiative and responsibility in all areas of patient care
as judged appropriate by the supervisor. These areas may include, but are not limited to:
The student researches the condition for FOC and ROC and can demonstrate their
research by exhibiting clear understanding of the pathophysiology, biochemistry and a
differential diagnosis during case discussion.
The student has read and reviewed existing chart notes and is familiar with current and
past treatment plans and outcomes.
The student initiates study and outside prep work and will meet the supervisor to discuss
patient cases and treatment on their own initiative as necessary.
The student comes to case preview and review prepared to discuss all cases.
The student makes note of medical records ordered and has reviewed them by the
patient’s next visit after their arrival.

The student receives an AC grade if:
Early Primary – demonstrates the above skills, with coaching from supervisor, on at least
80% of all cases
Mid Primary – demonstrates the above skills, with minimal coaching, on at least 80% of
all cases.
Late-Primary – demonstrates the above skills, without coaching, on at least 80% of all
cases.

The student receives a PC grade if:
Early Primary – demonstrates the above skills, with coaching from supervisor, on
70-79% of cases.
Mid Primary - demonstrates the above skills, with minimal coaching from supervisor on
70-79% of cases.
Late Primary – demonstrates the above skills, without coaching, on 70-79% of cases. To
rectify a PC, the student is given two cases to evaluate. The student prepares and meets
the faculty to discuss pathophysiology, appropriate biochemistry, diagnostic testing and
physical exam as well as ddx and ND/MD treatment commonly utilized for the
conditions.

The student receives an F grade if:

Early Primary – demonstrates the above skills, with coaching from supervisor, on less
that 70% of cases.
Mid Primary – demonstrates the above skills, with minimal coaching from supervisor, on
less than 70% of cases.
Late Primary – demonstrates the above skills, without coaching, on less than 70% of
cases.



                                          Page 67
2. Communication Skills and Rapport with Patients

Skills that must be demonstrated in the category to receive an AC:

The student speaks clearly to the patient.
The student demonstrates active listening while interviewing the patient.
The student demonstrates empathy with the patient.
The student conducts self in an open, non-judgmental way to all information disclosed by
the patient.
The student addresses all stated concerns of the patient.
The student attempts to ascertain and address the unstated needs/concerns of the patient.

The student receives an AC grade if:

Early Primary –demonstrates all of the above skills, with coaching from supervisor on at
least 80% of cases.
Mid Primary – demonstrates the above skills, with minimal coaching, on at least 80% of
cases.
Late Primary – demonstrates the above skills, without coaching, on at least 80% of the
cases.

The student receives a PC grade if:

Early Primary – demonstrates all of the above skills, with coaching from supervisor, on
70-79% of the cases.
Mid Primary – demonstrates all of the above skills, with minimal coaching, on 70-79% of
cases.
Late Primary – demonstrates all of the above skills, without coaching, on 70-79% cases.

To rectify a PC grade the student will conduct 5 interviews and successfully demonstrate
the skills listed above on at least four of them.

The student receives an F grade if:

Early Primary – demonstrates all of the above skills, with coaching from supervisor, on
less than 70% of the cases.
Mid Primary –demonstrates above skills, with minimal coaching, on less than 70% of
cases.
Late Primary – demonstrates above skills without coaching, on less than 70% of cases.




                                        Page 68
3. Interviewing Skills

Skills that must be demonstrated in this category to achieve AC:

The student obtains a thorough case history from the patient, as detailed in “A Guide to
Physical Examination and History Taking” by Bates, including, but not limited to:

History of the present illness (HPI)
Past medical history
Current Health Status
Family History
Psychosocial History
Review of Systems

The student demonstrates the ability to perform special interview techniques in areas
such as gynecology, drug and alcohol dependence, STD risk profile, psychological risk
and history, etc.

The student demonstrates the ability to ask questions to ascertain the present risk to
patient safety and safety of others when indicated.

The student demonstrates the ability to efficiently assimilate the written and verbal
information gathered during the patient visit and maximize use of visit time.

The student receives an AC grade if:
Early Primary – demonstrates the above skills, with coaching from supervisor, on at least
80% of all cases.
Mid Primary – demonstrates all of the above skills, with minimal coaching on at least
80% of all cases.
Late Primary – demonstrates the above skills, without coaching, on at least 80% of cases.

The student receives a PC grade if:
Early Primary – demonstrates the above skills, with coaching from supervisor, on 70-
79% of cases.
Mid Primary – demonstrates the above skills, with minimal coaching on 70-79% of cases.
Late Primary – demonstrates the above skills, without coaching, on 70-79% of cases.

To rectify a PC grade, the student will participate in three mock interviews to
demonstrate the above skills. The conditions utilized in the interview will be taken from
the condition list in the clinic notebook. The student will be successful on at least two of
the cases.




                                         Page 69
The student receives an F grade if:

Early Primary – demonstrates the above skills, with coaching from supervisor, on less
that 70% of cases.
Mid Primary – demonstrates the above skills, with minimal coaching, on less than 70%
of cases.
Late Primary – demonstrates the above skills, without coaching, on less that 70% of
cases.

4)   Physical Exam Skills

Skills that must be demonstrated in this category to achieve AC:

The student shows the ability to perform any exam on request of supervisor, or as
indicated by patient chief complaint, within a reasonable time frame.
The student has equipment in all working order.
The student notifies the supervisor of all positive finding in time to be review by the
supervisor.
The student shows the ability to perform the exam and adapt to individual patient
circumstances and comfort.
The student always has appropriate faculty supervision before performing any male or
female genital exam.

The student receives an AC grade if:
Early Primary – demonstrate above skills on 80% of cases. They may require prompting
on 2-3 components of the exam. They may require more time to prepare and perform the
exams.
Mid Primary – they complete the exam in allotted time and demonstrate adequate
technique on at least 80% of cases. They will require no prompting when they have
preparation time and minimal prompting with preparation.
Late Primary – they demonstrate skill level of graduating physician, complete the exam
in allotted time and require no prompting on 90% of cases.

The student receives a PC grade if:

Early Primary – they demonstrate the above skills 70 –79% of cases and require
prompting on more than three components of the exam.
Mid Primary – demonstrate 70 –79% of cases. They should require no prompting when
they have had preparation time and minimal prompting without preparation.
Late Primary – they demonstrate the above skills on 80 –89% of cases. They should
have the skill level of graduating physicians, complete the exam in allotted time and
require no prompting.

To rectify a PC the student must perform three exams, reflecting appropriate skill level,
during interim or substitute shifts.

                                         Page 70
The students receives an F grade if:

Early Primary– they demonstrate the above skills, with supervisor assistance, less than
70% of the time.
Mid Primary – they demonstrate the above skills, with minimal assistance, less than 70%
of the time.
Late Primary – they demonstrate the above skills, without assistance, less than 70% of
the time.




                                       Page 71
5. Overall Case Management

Skills that must be demonstrated in this category to achieve an AC:

The student demonstrates understanding of treatment plan goals by monitoring patient
progress and suggesting alterations to the plan when indicated.
The student indicates understanding of the goals of case management by following up on
referrals, diagnostic testing results, and recommending changes to the plan as indicated
by patient needs.
The student follows up patient case management with authorized telephone calls to the
patient to monitor treatment progress, when indicated.
The student indicates understanding of the impact of treatment pathophysiology when
recommending alterations to the treatment plan.

The student receives an AC grade when:

Early primary – they demonstrate proficiency, with coaching from supervisor, on at least
80% of the cases.
Mid primary – they demonstrate proficiency, with minimal coaching and increasing depth
and breadth of plan, on at least 80% of the cases.
Late primary – demonstrate graduate level proficiency on at least 80% of cases.

The student receives a PC grade when:

Early primary – they demonstrate the above skills on 70 –79% of cases, with assistance
of their supervisor.
Mid primary – they demonstrate the above skills, with minimal assistance, on 70-79% of
cases.
Late primary – they demonstrate the above skills, at graduate physician level of
competence, on 70-79% of the cases.

To rectify a PC grade, the student would present treatment plans for 3 FOC cases
presented by supervisor and adapt the plans through two ROCs as presented by
supervisor. The plans will represent appropriate complexity and knowledge of
pathophysiology representative of current education status.

The student receives an F grade when:

Early primary – they demonstrate the above skills, with prompting, on less than 70% of
the cases.
Mid primary – they demonstrate the above skills, with minimal prompt on less than 70%
of the cases.
Late primary – they demonstrate the above skills on less than 70% of cases.




                                        Page 72
6. Charting Techniques

Skills that must be demonstrated in this category to achieve an AC:

Charting is completed within 24 hours of patient visit unless exception is approved by
supervisor. Corrections made to chart, as directed by supervisor, are completed within 24
hours of notification, unless exception is granted by supervisor.
Chart notes with basic case information are left in the incomplete chart.
Chart is presented in proper soap format and organized properly in the chart folder. Each
complaint is identified and information about that complaint listed separately from other
complaints.
Chart is legible and completed in black ink.
FOC chart utilizes accepted forms with patient name, date of birth and date of visit on
each page.
On an ROC chart, each page is dated and identified with patient name and DOB. If more
than one page is used, each page is numbered and identified.
The patient summary is completed for each visit.
The student utilizes medical terminology in all sections of the chart.
There are minimal grammatical and spelling errors, including medications.
Treatment plans include rationale, dosage and contraindications of medications when
appropriate. The also include all activities and update all ongoing treatment. Each
treatment plan should stand alone.

The student receives an AC if:
Early primary – the above skills are demonstrated, with correction by supervisor, on at
least 80% of charts.
Mid primary – the above skills are demonstrated, with minimal correction, on at least
80% of charts.
Late primary – the above skills are demonstrated, without correction, on at least 80% of
charts.

The student receives a PC if:
Early primary – the above skills are demonstrated, with correction by supervisor, on 70 –
79% of charts.
Mid primary – the above skills are demonstrated, with minimal correction by supervisor,
on 70-79% of charts.
Late primary – the above skills are demonstrated, without correction, on 70-79% of
charts.

To rectify a PC grade, the student will write up three properly completed charts. They
must be submitted within the time deadline decided by supervisor. The charts must be
completed on patient visits when acting as a substitute clinician or during interim clinic.

A failure is received when the student:
At all levels, meets the above standards less than 70% of the time.

                                         Page 73
7. Application of academic learning to clinical training and patient care.

Skills which must be demonstrated in this category to achieve an AC:

The student must demonstrate understanding of the pathophysiology, anatomy and
biochemistry as they relate to patient complaints and diagnosis in case discussion,
preview and review.
Demonstrate the ability to triage acute patient presentations.
Regularly demonstrate evidence of case preparation by including research about
conditions in case discussions.
Demonstrate understanding of laboratory and diagnostic testing results and their impact
on diagnosis and treatment.
Demonstrate understanding of psychological component of patient complaints and
diagnoses and methods of intervention.

The student receives an AC grade if:

Early primary – they demonstrate the above skills, with assistance from supervisor, on
80% or more of cases.
Mid primary – they demonstrate above skills, with minimal assistance, on 80% or more
of cases.
Late primary – they demonstrate the above skills, without assistance, on at least 80% of
cases.

The student receives a PC if:

Early primary – above skills are demonstrated, with assistance from supervisor, on 70-
79% of cases.
Mid primary – above skills are demonstrated, with minimal assistance, on 70-79% of
cases.
Late primary – above skills are demonstrated, without assistance, on 70-79% of cases.

To rectify a PC grade, the student would demonstrate knowledge of above skills, on two
cases from the required conditions list, to supervising faculty.

Student receives an F grade if:

Early primary – above skills are demonstrated, with assistance from supervisor, on less
than 70% of cases.
Mid primary – above skills are demonstrated, with minimal assistance, on less than 70%
of cases.
Late primary – above skills are demonstrated, without assistance, on less that 70% of
cases.



                                        Page 74
8. Differential Diagnosis/Assessment Skills

Skills which must be demonstrated in this category to achieve an AC include:

Student must be able to create a problem list, a DDX list and make an appropriate
diagnosis.
If a diagnosis or condition is listed on the assessment as a rule out, a mechanism should
be included in the plan for ruling out the condition.
The plan should include the steps necessary to arrive at a definitive diagnosis.
The problem list should include patient concerns not addressed by that day’s treatment
which may be indicated by medical history.
Diagnoses should be carried forward in the chart for each visit until resolved.
The differential diagnosis list should include the most probable and most potentially
serious diseases which may be the diagnosis.


The student receives an AC if:

Early primary – they demonstrate above skills, with assistance from supervisor, on 80%
or more of cases.
Mid primary – they demonstrate above skills, with minimal assistance, on at least 80% of
cases.
Late primary – they demonstrate above skills, without assistance, on at least 80% of
cases.

The student receives a PC grade if:

Early primary – they demonstrate above skills, with assistance, on 70 – 79% of cases.
Mid primary – they demonstrate above skills, with minimal assistance, on 70 – 79% of
cases.
Late primary – they demonstrate above skills, without assistance, on 70 – 79% of cases.

That may rectify a PC grade by demonstrating appropriate skill at differential diagnosis
on four cases presented by the supervising faculty.

The student receives an F grade if:

Early primary – they demonstrate above skills, with assistance, on less than 70% of
cases.
Mid primary – they demonstrate above skills, with minimal assistance, on less than 70%
of cases.
Late primary – they demonstrate above skills, without assistance, on less than 70% of
cases.


                                         Page 75
9. Knowledge of Naturopathic Therapies and their Proper Application:

Skills that must be demonstrated in this category to achieve AC:

The student prepares therapeutic options for each case before preview and is able to
discuss rationale, strategy and therapeutic goals.
The student demonstrates the ability to choose appropriate therapies to suit individual
patient circumstances.
The student is able to prepare a treatment plan in an acute situation within
    the given time constraints.
The student is familiar with the contents of supplement formulas intended for use or
previously prescribed for the patient.
The student is able to identify all of our modalities available for treatment of the
individual patient and their condition and to discuss rationale for use of those modalities.
The student is able to recommend dosages of supplements, botanicals and homeopathics
in a safe and therapeutic range.
The student is able to incorporate the use of Naturopathic principles into a treatment plan
and can discus how the principles are integrated into the plan.

The student receives an AC grade if:
Early primary – demonstrates all of the above skills, with coaching from supervisor, on at
least 80% of the cases.
Mid-primary- demonstrates all of the above skills, with increased depth of knowledge
and minimal coaching, on at least 80% of the cases.
Late primary – demonstrates all of the above skill, with the depth of knowledge of a
graduating clinician and demonstrates increased versatility with therapeutic agents. The
student is able to develop a treatment plan, without supervision, on at least 80% of cases.

The student receives a PC grade if:
Early primary – demonstrates all of the above skills, with coaching, on 70 – 79% of
cases.
Mid primary – demonstrates all of the above skills, with increased depth of knowledge,
on 70 – 79% of cases.
Late primary – demonstrates all of the above skills, with increased depth of knowledge,
versatility with therapeutic agents and without supervision from supervisor, on 70 – 79%
of cases.

To rectify a PC grade the student will be assigned 5 cases from the supervisors case load
and be required to formulate specific alternative treatment plans for the given conditions.
These treatments will be reviewed and discussed with the supervisor. At least four of the
five cases must demonstrate the skills listed above.

The student receives an F grade if:
Early primary – demonstrates the above skills with assistance on less than 70% of cases.
Mid primary – demonstrates all the above skills, with increasing depth of knowledge, on
less than 70% of cases.

                                         Page 76
Late primary – demonstrates the above skills, with increasing depth of knowledge, on less than
70% of cases.




                                               Page 77
10.   Patient Follow-up Skills

Skills that must be demonstrated in this category to achieve an AC:
The student demonstrates initiative in patient follow-up. For example, pursuing pre-
approval of phone calls, performing additional research on a case study, integrating
appropriate referrals, etc.
The student meets the supervisor near the end of the quarter to coordinate transition for
care in the next quarter, and notifies the patients involved.
The student develops the ability to keep phone contacts brief and to the point.
The student completes referral letter, intraclinic referral letter, release of record forms,
future lab forms and any other necessary paperwork for continuation of care in a timely
fashion.

The student receives an AC grade if:

Early primary – demonstrates the above skills on greater than 80% of cases with
assistance of supervisor.
Mid primary – demonstrates the above skills on greater than 80% of the cases with
minimal assistance.
Late primary – demonstrates the above skills without assistance on more than 80% of
cases.

The student receives a PC grade if:

Early primary – demonstrates the above skills, with assistance, on 70 – 79% of cases.
Mid primary – demonstrates the above skills, with minimal assistance, on yet 70 – 79%
of cases.
Late primary – demonstrates the above skills, without assistance, on 70 – 79% of cases.

To rectify a PC grade the student must develop detailed follow-up plans for 5 cases that
demonstrate knowledge of appropriate screening exam intervals and length of duration of
specific therapeutic agents.

The student receives an F grade if:

The primary clinician demonstrates the above skills on less than 70% of cases despite
assistance of supervisor.




                                          Page 78
11. Listening Skills

Skills that must be demonstrated in this category to achieve an AC:

The student demonstrates the ability to hear the patient by giving a summary of the
patient history accurately to the supervisor.
The student demonstrates the ability to assimilate and integrate the patient’s verbal and
written information and minimize the asking of redundant questions.
The student demonstrates the ability to recognize patient concerns even when they are not
clearly articulated by the patient.
The student will listen to the supervisor and follow verbal instructions.

The student receives an AC grade if:

Early primary – demonstrates all of the above skills, with coaching from supervisor, on at
least 80% of cases.
Mid primary – demonstrates all of the above skills, with minimal coaching from
supervisor, on at least 80% of the cases.
Late primary – demonstrates all of the above skills, without coaching, on at least 80% of
cases seen.

The student receives a PC grade if:

Early primary – demonstrates the above skills, with coaching on 70 – 79% of cases.
Mid primary – demonstrates the above skills, with minimal coaching on 70 – 79% of
cases.
Late primary – demonstrates the above skills, without coaching on 70 – 79% of cases.

The student rectifies a PC by taking a maximum of 3-4 cases, recognizing the defects in
their skills and demonstrating adequate competency in at least three cases. A videotape
may be made in these cases and used to demonstrate areas of inadequacy for the student.

The student receives an F grade if:

A student of any level demonstrates less than 70% achievement on all of the above skills.




                                        Page 79
12. Time Management Skills

Skills that must be demonstrated in this category to achieve an AC:
 The student demonstrates the ability to take an appropriate history, perform the
appropriate physical exam(s), meet with supervisor, make an assessment and diagnosis,
create a treatment plan and explain the plan to the patient in the allotted period of time.
 The student arrives to case preview and review on time, and participates actively in both.
 The student complies with deadlines in charting, patient follow-up and responding to
patient and supervisor requests.

The student receives and AC grade if:

Early primary – demonstrates the above skills, with supervisor coaching, on at least 80%
of cases.
Mid-primary – demonstrates the above skills, with minimal coaching, on at least 80% of
cases.
Late primary – demonstrates the above skills, without coaching on at least 80% of cases.

The student receives a PC grade if:

All levels – demonstrates the skills listed above on 70 – 79% of cases.

A PC may be converted to an AC by demonstrating successful time management on all 3
occasions of mock interviews set up by the student with supervision. Content of the
interview will be evaluated as well as the time management aspect. This may also be
accomplished during an interim clinic shift upon approval of supervisors.

The student receives an F grade if:

All levels – the student demonstrates the above skills on less than 70% of patient visits.




                                         Page 80
13. Cooperation with Clinic Supervisors and Staff

Skills that must be demonstrated in this category to achieve AC:

The student demonstrates the ability to work as part of a team, for the well being of the
patient.
The student demonstrates the ability to interact with all clinic staff, faculty and
colleagues in a professional manner that optimizes patient care.
The student communicates accurately to the patient specific recommendations approved
by the supervisor and does not make treatment suggestions to the patient without the
approval of the supervisor.

The student receives an AC grade if:

Early primary – demonstrates the above skills, with coaching by the supervisor, on at
least 80% of cases.
Mid primary – demonstrates the above skills, with minimal coaching from the supervisor,
on at least 80% of cases.
Late primary – demonstrates all of the above skills, without coaching from the
supervisor, on 80% of cases.

There is no PC grade for this clinical skill. If a student demonstrates a deliberate lack of
cooperation with others that results in delay, confusion, error, omission, conflict or extra
work regarding patient management or jeopardizes patient rapport, a warning letter is
written to the student on the first offense. A failure event may also be given at the
discretion of the supervisor.

The student receives an F grade if:

Additional episodes of deliberate lack of cooperation occur during the rest of the quarter.




                                          Page 81
14. Communication Skills with Peers and Supervising Doctors

Skills that must be demonstrated in this category to achieve AC:

The student demonstrates an articulate and summarized presentation of cases in preview
and review.
The student demonstrates the ability to summarize the patient’s case to the supervisor in a
complete, coherent and concise manner.
The student demonstrates the ability to communicate effectively with their secondary
clinician in a way that best facilitates case management.
The student communicates relevant details from the interview which have a bearing on
case management (including, but not limited to, suicidal thought or a recent history of an
eating disorder or recent trauma).

The student receives an AC grade if:

Early primary – demonstrates the above skills on 80% of cases with supervisor coaching.
Mid primary – demonstrates the above skills on 80% of cases with minimal coaching.
Late primary – demonstrates the above skills on 80% of cases without coaching.

The student receives a PC grade if:

Early primary – demonstrates the above skills on 70 – 79% of cases with supervisor
coaching.
Mid primary – demonstrates the above skills 70 – 79% of cases with minimal coaching.
Late primary – demonstrates the above skills without coaching 70 – 79% of cases.

To rectify a PC grade the student must meet with the supervisor and present five cases,
successfully demonstrating the above skills on four out of the five.

The student receives an F grade if:

Early primary - demonstrates the above skills on less than 70% of cases with supervisor
coaching.
Mid primary – demonstrates the above skills on less than 70% of cases despite minimal
coaching.
Late primary – demonstrates the above skills on less than 70% of the cases without
coaching.




                                        Page 82
15. Motivation and Initiative in Learning Clinical Skills

Skills that must be demonstrated in this category to achieve AC:

The student will demonstrate motivation and initiative by using clinical time not taken up
with patient care in a way which enhances clinical skills and education. This would
include, but is not limited to:

using clinic educational resources to study a condition.
practicing physical exam skills.
reviewing medical references relating to a patient’s complaint or treatment.
expanding therapeutic knowledge.
familiarizing oneself with dispensary products and indications for use.
sitting in on case discussions of other primary clinicians.

The student receives a AC grade if:

Early primary – demonstrates initiative in the above areas, with direction from the
supervisor, on 80% or more of all shifts.
Mid primary - demonstrates initiative in the above areas, with minimal direction, on at
least 80% of all shifts.
Late primary – demonstrates initiative in the above areas, without direction, on at least
80% of all shifts.

The student receives a PC grade if:

Early primary – demonstrates initiative in the above areas, with direction from the
supervisor, on 70 – 79% of shifts.
Mid primary – demonstrates initiative in the above areas, with minimal direction from the
supervisor, on 70 – 79% of shifts.
Late primary – demonstrates initiative in the above areas, without direction, on 70 – 79%
of shifts.

To rectify a PC grade a student must be observed actively enhancing their clinical skills
in the aforementioned ways during times they are not seeing patients. The number of
hours devoted to this additional study must equal the number of hours that were not well
spent on their clinic shift. Other supervisors may assist in keeping track of these
additional hours.

The student receives an F grade if:

The student demonstrates the above skills on less than 70% of all shifts.




                                         Page 83
16. Familiarity with Clinic Policies and Procedures and Efficacy in Following Them

Skills that must be demonstrated in this category to achieve AC:

The student will demonstrate competency in this area by adhering to all policies outlined
in the clinic SOP notebook and University policies as outlined in the handbook.

The student receives an AC grade if:

All primary clinicians must be in compliance with the written policies on 80% or more of
the shifts. This would allow policy violations on not more than two occasions during the
eleven-week quarter. There are certain policies and procedures which may result in
immediate failure of the shift or quarter when violated. (Example: removal of a chart
from clinic premises. Please review SOP notebook.)

The student receives a PC grade if:

Any primary clinician who is in compliance with the written policies on 70 – 79% of the
shifts will receive a PC. This is roughly equal to 3 policy violations during the eleven-
week quarter.

To rectify a PC the student must pass with 80% or better an equal quiz on policies in the
SOP notebook given by the supervisor or other faculty. No further violations can occur
during the quarter. There is no rectifying a violation of certain policies as noted in the
notebook.

The student receives an F grade if:

Any primary clinician who is in compliance with written policies on less than 70% of the
shifts will receive an F. This would mean the student has violated policy on four
occasions during the quarter. There are certain policies in the notebook which call for
immediate sanction as in loss of one shift (hours and patient contacts) or in loss of credit
for the quarter. Please review the notebook.




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Section B – Secondary Clinicians


1. Initiative and responsibility in role as a secondary clinician
2. Cooperation with clinical supervisors and staff
3. Familiarity with clinic policies and procedures and efficiency in following them
4. Physical exam skills
5. Application of academic learning to clinical training
6. General overview of case management
7. Listening skills
8. Communication skills and rapport with peers and supervisors
9. Time management skills
10. Motivation and initiative in learning clinical skills
11. Participation and input in case discussion on shift


                .




                                        Page 85
1. Initiative and Responsibility in Role as Secondary Clinician

Skills that must be demonstrated to achieve an AC include:

The student demonstrates initiative and responsibility by reviewing pathophysiology,
biochemistry, differential diagnosis and treatment(s) for chief complaints listed on a
patient FOC.
The student reviews patient charts for ROCs and demonstrates understanding by
knowledgeable participation in case preview.
The student is familiar with each case seen that day and by case review can
knowledgeably participate and present cases when requested to do so by supervisor.

The student receives an AC if:

Early secondary – demonstrates above skills, with assistance of supervisor, on more than
80% of cases.
Late secondary – demonstrates above skills, without assistance, on more than 80% of
cases.

The student receives a PC if:

Early secondary – demonstrates above skills, with assistance, on 70 – 79% of cases.
Late secondary – demonstrates above skills, without assistance, on 70 – 79% of cases.

A PC may be rectified by study of two cases and demonstrating knowledge of
pathophysiology and differential diagnosis in mock case review with a supervisor.

The student receives an F if:

Early secondary – demonstrates above skills, with assistance, on less than 70% of cases.
Late secondary – demonstrates above skills on less than 70% of the cases.




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2. Cooperation with Clinical Supervisors and Staff

Skills which must be demonstrated to achieve an AC include:

The student demonstrates teamwork by presenting paperwork needed on shift and coordinates
completion by supervisor and primary.
The student exhibits knowledge of location of forms and has adequate supply on hand for each
visit.
Oversees dispensary paperwork completion and verifies product(s) chosen are available for the
patient.
Make sure superbill is completed and signed and processed by departments as indicated.
Make sure lab requisition and paperwork is completed and routed for processing.
Transfers any PE information they gather during visit to primary for inclusion in the chart.
The student demonstrates teamwork by active participation to patient management in appropriate
ways with the supervisor and primary clinician. (Example: Coordinates their questions to those
of the primary and supervisor in both content and timing of the questions.)
Informs front desk staff if visit is running late.
Informs the dispensary if visit is running late and a prescription is to be processed for late
patient.

The student receives an AC if:

Early secondary – above skills are demonstrated, with assistance from supervisor, on 80% of
more cases.
Late secondary – above skills are demonstrated, without assistance, on at least 80% of cases.

There is no PC for this category

The student receives an F if:

Early secondary – above skills are demonstrated, with assistance of supervisor, on less than 80%
of cases.
Late secondary – above skills are demonstrated, without assistance, on less than 80% of cases.




                                                Page 87
3. Familiarity with Clinic Policies and Procedures and Efficiency in Following Them

Skills which must be demonstrated for the student to receive an AC:

The student stocks the exam room with necessary supplies for each shift.
The student accompanies the patient to and from restroom, lab, dispensary, front desk or
other designated areas in the clinic
The student verifies that the patient is aware of proper specimen techniques.
The student sets up the room to accommodate any planned procedure before the visit.
The student notifies waiting patients when previous visit is running over time allotted.
The student returns room to order and replaces used supplies at end of visit. Returns
borrowed equipment to proper/original location.
The student disinfects room at end of each patient visit.
The student has clinic paperwork signed off by the supervisor at the end of each shift.
The student has knowledge of clinic SOPs (from handbook) and follows them.
The student follows proper biohazard handling and disposal techniques.

The student receives an AC if:

Early secondary – they perform above skills, with assistance of supervisor, on at least
80% of cases.
Late secondary – they perform above skills, without assistance, on at least 80% of cases.

There is no PC for this category

The student receives an F if:

Early secondary – they perform above skills, with assistance of supervisor, on less than
80% of cases.
Late secondary – they perform above skills, without assistance, on less than 80% of
cases.




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4. Physical Exam Skills

Skills that must be demonstrated for the student to receive an AC:

The student takes vital signs, using appropriate technique, for each patient on each visit.
The student reports vitals to the supervisor when they are abnormal, and makes sure the
information is recorded accurately in the chart.
The student repeats exams on patient when requested to do so by primary clinician or supervisor.
The student must bring diagnostic equipment to clinic and have their equipment in good working
order.

The student will receive an AC if:

The student, at all levels of experience, will receive an AC if they perform the above skills on at
least 80% of cases.

The student will receive a PC if:

The student, at all levels of experience, will receive a PC grade if they perform the above skills
on 70 – 79% of cases.
A PC may be rectified by:
demonstrating appropriate techniques taking vital signs
appropriate recording of vitals in the chart
the possession of diagnostic equipment in good working order

All skills to be assessed by the supervisor on three occasions on a substitute or interim clinic
shift.

The student will receive an F grade if they perform the above skills less than 70% of the time.




                                                 Page 89
5. Application of Academic Learning to Clinical Training

Skills that must be demonstrated for the student to receive an AC:

The student demonstrates understanding of pathophysiology, anatomy and biochemistry
as they relate to patient complaints and diagnosis in case discussion, preview and review.
The student demonstrates evidence of case preparation by including research about
conditions in cases discussion.
Can explain purpose and function behind lab or diagnostic testing to patient when ask to
do so
Can actively participate in case discussions with supervisors and primary.

The student will receive an AC if:

Early secondary – perform above skills, with minimal assistance of supervisor, or more
than 80% of cases.
Late secondary – perform above skills, without assistance, on more than 80% of cases.

The student will receive a PC if:

Early secondary – perform above skills, with minimal assistance from supervisor, on 70 –
79% of cases.
Late secondary – perform above skills, without assistance, on 70 – 79% of cases.

A student may rectify a PC by completing assignment of three case analyses with
supervisor. These cases will include the following components:
       Identify the chief complaint and seven attributes
       Describe objective findings utilizing appropriate terminology
       Be able to formulate and defend a differential diagnosis and include testing done
       to confirm diagnoses.

The student will receive an F if:

Early secondary – perform above skills, with minimal assistance from supervisor, on less
than 70% of cases.
Late secondary – perform above skills, without assistance, on less than 70% of cases.




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6. General Overview of Case Management

Skills that must be demonstrated in this category to achieve an AC:

The student exhibits understanding of case management by participating in case discussion
utilizing knowledge of pathophysiology, biochemistry to support the differential diagnoses.
The student can explain the purpose of any diagnostic tests ordered and the meaning of the
results received and how they apply to the case under discussion.
The student can formulate treatment options during case discussion and support choice of
treatment utilizing clinical thinking skills.
The student can assess and identify pertinent patient findings.
The student can discuss the significance that lifestyle modifications would have for the patient’s
health.
The student demonstrates the ability to prioritize the patient’s concerns.
The student can discuss the case in terms of the Naturopathic principles and identify the
principles which were and were not utilized in each case.

The student receives an AC grade if:

Early secondary – demonstrates all of the above skills, with supervisor assistance, on at least
80% of cases.
Late secondary – demonstrates all of the above skills, without assistance, on at least 80% of
cases.

The student receives a PC grade if:

Early secondary – demonstrates all the above, with supervisor assistance, on 70 – 79% of cases.
Late secondary - demonstrates all of the above, without assistance, on 70 – 79% of cases.

To rectify a PC grade the student must study 3 additional cases and be able to discuss relevant
features of each case including history, physical exam and relevant diagnostic findings,
assessment and treatment plan with the supervisor. The student must demonstrate proficiency on
at least four of the five cases.

The student receives an F grade if:

Early secondary – demonstrates the above skills, with supervisor assistance on less than 70% of
cases.
Late secondary – demonstrates the above skills, without assistance, on less than 70% of cases.




7. Listening Skills


                                                 Page 91
Skills that must be demonstrated in the category to achieve an AC:
The student actively follows the case taking and inserts appropriate questions at indicated
times during the visit.
The student notes requests by the patient during the visit to be fulfilled by the dispensary
or supervisor.
The student observes the patient during the interview and reports pertinent observations
to the primary and supervisor.
The student demonstrates communications skills which emphasize patient needs and are
culturally and socially sensitive to patient gender, lifestyle, culture and socioeconomic
status.

The student receives an AC grade if:

Early secondary – demonstrates all of the above skills, with supervisor assistance, on at
least 80% of cases.
Late secondary – demonstrates all of the above skills, without assistance, on at least 80%
of cases.

There is no PC given for this clinical competency.

The students receives an F grade if:

Early secondary – demonstrates the above skills, with supervisor assistance, on less than
80% of cases.
Late secondary - demonstrates the above skills, without assistance, less than 80% of
cases.




8. Communication Skills with Peers and Supervisors

                                         Page 92
Skills that must be demonstrated in the category to achieve an AC:

The student discusses their role with primary clinical and supervisor and elicits feedback
on their performance.
The student contributes comments and questions during case discussion which contribute
to the flow, and reserves adjunctive questions for later discussion.
The student is able to present a case, in a concise, summarized, cohesive presentation, in
case review and case preview within 3 – 5 minutes.

The student receives an AC grade when:

Early secondary – they demonstrate all of the above skills, with supervisor assistance, on
at least 80% of cases.
Late secondary – they demonstrate all of the above skills, without assistance, on at least
80% of cases.

The student receives a PC grade when:

Early secondary – they demonstrate the above skills, with supervisor assistance, on 70 –
79% of cases.
Late secondary – they demonstrate the above skills, without assistance, on 70 – 79% of
cases.

To rectify a PC grade a student must successfully present a case preview or review where
the supervisor is present.

The student receives an F grade when:

Early secondary – they demonstrate the above skills, with supervisor assistance, on less
than 70% of cases.
Late secondary – they demonstrate the above skills, without assistance, on less than 70%
of cases.




9. Time Management Skills


                                        Page 93
Skills that must be demonstrated in this category to achieve an AC:
The student assists the primary in completing the visit on time by demonstrating
appropriate communication skills, being prepared with appropriate paperwork, and
efficiently completing any needed paperwork.
The student acts as a timekeeper for the primary when needed and informs the next
waiting patient and the front desk if the visit is running over time.
The student completes vital signs within 5 minutes.
The student completes the paperwork in a timely manner.
The student has made sure the exam room is adequately stocked to avoid delays.
The student arrives on time for the shift.

The student receives an AC grade when:

Early secondary – they demonstrate all of the above skills, with assistance from
supervisor, on at least 80% of cases.
Late secondary – they demonstrate all of the above skills, without assistance, on at least
80% of cases.

There is no PC grade for this clinical competency.

Early secondary – they demonstrate the above skills with assistance, on less than 80% of
cases.
Late secondary – they demonstrate the above skills without assistance, on less than 80%
of cases.




                                         Page 94
10. Motivation and Initiative in Learning Clinical Skills

Skills that a student must demonstrate in this category to achieve an AC:
The student demonstrates self motivation in researching and expanding their knowledge
base of Naturopathic medicine by showing an increased breadth an depth of knowledge
in their contributions to case discussion.
The student uses non-patient clinical time in a way which enhances clinical skills and
education. This would include, but not limited to:
using library resources to study a condition
practicing physical exams
reviewing medical references related to patient’s condition or treatment
familiarizing oneself with commonly used diagnostic tests.
familiarizing oneself with commonly used diagnostic tests.
reviewing the emergency treatment kit
sitting in on other case discussions

The student receives an AC grade when:

Early secondary – they demonstrate all of the above skills, with supervisor assistance, on
at least 80% of cases.
Late secondary – they demonstrate all of the above skills, without assistance, on at least
80% of cases.

The student receives a PC grade when:

Early secondary – they demonstrate all of the above skills, with supervisor assistance, on
70 – 79% of cases.

To rectify a PC grade the student must be observed actively enhancing their clinical skills
in the above-mentioned ways or other ways delineated by supervisor on non-shift time.
The number of hours devoted to this additional study must equal the number of hours that
were not utilized well during the clinic shift. Other supervisors may assist in keeping
track of these additional hours

The student receives an F grade when:

Early secondary – they demonstrate the above skills, with assistance, on less than 70% of
cases.
Late secondary – they demonstrate the above skills, without assistance, on less than 70%
of cases.




                                         Page 95
11. Participation and Input in Case Discussions on Shift

Skills that must be demonstrated in this category to achieve an AC:

The student attends case preview and review and provides input on a consistent basis and
in an appropriate manner.
The student contributes observations and input about the case during the case
management discussion, case preview or review.

The student receives an AC grade when:

Early secondary – they demonstrate all of the above skills, with supervisor assistance, on
at least 80% of cases.
Late secondary – they demonstrate all of the above skills, without assistance, on at least
80% of cases.

The student receives a PC grade when:

Early secondary - they demonstrate all the above skills, with supervisor assistance, on 70
– 79% of cases.
Late secondary – they demonstrate all of the above skills, without assistance, on 70 –
79% of cases.

To rectify a PC grade the student must attend four additional case preview or reviews and
join in case discussion by presenting the case of a patient they have seen, in a concise,
summarized, cohesive presentation (maximum of 5 minutes).

The student receives a F grade when:

All levels – they demonstrate the above skills on less than 70% of the cases.




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COMPETENCIES:

In addition to, and separate from achieving competencies for all clinic shifts, students are
required to competently perform the skills outlined in the list of Clinical Competencies.
It is the student’s responsibility to complete these competencies according to the timeline
outlined in the Competency Section. Clinical supervisors must sign off on these
competencies, and paperwork documenting satisfactory completion of competencies must
be turned in to the Clinic registration staff as each is completed. Please note: Clinical
Faculty signatures on clinical competencies does not assure AC grades on clinic shifts,
nor does it imply AC level work on any aspect of clinic shifts.

In order to graduate, a student must competently meet all clinic requirements and be
recommended for graduation by the Clinic Medical Director and those Clinical Faculty
who have supervised the student’s clinical education. Completion of clinic
requirements does not necessarily guarantee clinic Clinical Faculty’s
recommendation for awarding of degree.


Student Promotions Committee

The Student Promotions Committee consists of faculty from each department within the
university. The Vice President for Academics and Research, the Dean of Students and
the Registrar are non-voting members on the committee. This committee will evaluate
student academic performance every quarter. The committee will review records of those
students who have had academic concerns in the previous quarter(s). The committee will
look at the entire academic record of the student and make a determination as to the
appropriate course of action. The courses of action may include, but are not limited to, a
warning, learning contract, probation, suspension, or dismissal.

Dismissals from the university are automatic in the case of the following:
      Three failures in the same quarter
      Failures of the same class twice
      Failure of two clinic shifts
      Failure to satisfactorily complete a learning contract


Addendum: Clinic Academic Status Policy
In general, students must be in good academic standing to begin or to continue their
clinical training.
Students who are placed on restricted status are ineligible to register for clinical training
shifts until their academic standing is remedied.




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Students who receive 2 (two) F’s for the same clinical training shift, or any two clinical
training shifts, will be subject to dismissal as per Academic Sanction Policy. (See
preceding section.)


CONFIDENTIALITY POLICY

1. All patient records at the Bastyr Center for Natural health are confidential and subject
to the state and federal laws regulating the management, release, maintenance and
destruction of such records. This includes but is not limited to RCW 70.02 and standards
outlined by the Washington State Health Information Management Association
(WSHIMA).

2. Only authorized medical records staff are permitted to release any written patient
information from the clinic or to authorize transfer of patient records (such as transfers of
x-rays). Release of such information by students, staff or faculty is a violation of clinic
policy and grounds for disciplinary actions. See individual sections for policies
concerning release of records.

3. Patient records are maintained for the mutual benefit of the patient, the attending
healthcare professionals, student clinicians and the institution. The physical patient
record serves as the clinic’s official legal record of services rendered to each patient at
our facility and is property of the Bastyr Center for Natural Health. The information
contained in the chart includes personal and sensitive health information and is to be
handled with the utmost prudence. In addition, all records are subject to clinic
confidentiality policies. Violation of clinic confidentiality policy is grounds for
disciplinary action.

 4. All patient records are to remain in the building at all times, except under the lawful
practices of the Medical Records Coordinator. Clinicians and supervisors must be able to
account for all charts checked out to them at any given time, and records are never to be
left unattended in areas with public access.

 5. Providers and clinicians are entitled to read a patient’s chart on a ‘need to know’
basis. Generally this means that the clinician or attending provider is currently providing
or is scheduled to provide healthcare to the patient. However, since this is a teaching
clinic, patient records may be made available to student clinicians and attending
providers for the purposes of research, grand rounds work or instructional use.

6. Patient records for Bastyr students, LIOS students, clinic and campus staff, clinic and
campus faculty members and significant others of the same are available only to student
clinicians and attending providers directly involved in the individual’s healthcare or
responding to an emergent situation. All other access, except that necessary for
management and maintenance of the record by authorized record custodians, is strictly
prohibited. Such ‘restricted’ records are not to be discussed in preview or review sessions
and are never to be used for case presentations or grand rounds. This restriction remains

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on a record even after a student graduates, a staff or faculty member leaves the clinic or a
relationship with a significant other changes. Discussion of any Bastyr community
member’s clinic visits to anyone not involved in the patient’s care and for purposes other
than the patient’s care is prohibited.

7. Supervising physicians at the clinic may opt to restrict access to an individual’s chart
by notifying the Medical Records Supervisor. The Medical Records Supervisor will make
the necessary changes, and give the chart ‘Restricted’ status. When a chart is granted
restricted access it becomes exempt from access for research purposes by students,
instructional use, preview or review discussion, grand rounds use or access by those not
directly involved in the patient’s healthcare. A student clinician may not grant a record
restricted status.

 8. Non-restricted team care records are still subject to certain limitations. Patients and
their medical care can only be discussed in a manner that omits any identifying
information about the patient (i.e. name, specific occupation, address, identifying
relationship or identifying act). All discussions of medically related information is
restricted to the treatment room and designated preview-review areas. Discussion of
medical information in hallways, waiting rooms or other public areas is strictly
prohibited.

9. Photocopying patient records—even for educational purposes—is also prohibited. Due
to the difficulty in removing or ‘blacking-out’ a patient’s name or other uniquely
identifiable information, all medical information taken from a patient’s record for
research, educational purposes, grand rounds etc. must be handwritten and contain no
identifying information. Student clinicians and faculty are responsible for shredding all
such information after use.

10. Patient contact record sheets must only list the initials of the patient's name, and may
never contain identifying information.

Confidentiality is of paramount importance to the safety and well being of each patient.
This is a critical component of the professional code of ethics for all health professions.




                                          Page 99
PROFESSIONAL CONDUCT

This is the Code of Conduct for all members of the Bastyr University community.
Please see Student Handbook and Clinical Faculty Handbook.

The rights and privileges exercised by any person are always a function of their
relationships with others. Loss of privileges, specified disciplinary requirements or
separation from Bastyr University may be imposed on anyone whose conduct on or off
campus adversely affects the Bastyr University community, particularly when it shows
failure to accept responsibility for the welfare of other persons. Fundamental kinds of
misconduct, which may lead to suspension or dismissal, are:

1. Physical and/or verbal abuse, intimidation or harassment of another person or group.
2. Racist and/or sexist remarks and/or behavior towards another person or group.
3. Deliberate or careless endangerment; tampering with safety alarms or equipment;
   violation of specific safety regulations; and failure to render reasonable cooperation
   in an emergency.
4. Obstruction or forcible disruptions of regular Bastyr University activities, including
   teaching, research, administration, clinic services, discipline, organized events and
   operation and maintenance of facilities.
5. Interference with the free speech and movement of any academic and/or community
   members.
6. Dishonesty, including provision of false information, alteration or misuse of
   documents, plagiarism and other academic cheating, impersonation,
   misrepresentation or fraud.
7. Theft, abuse or unauthorized use of personal or Bastyr University property.
8. Use of illicit drugs or being on the premises in a drug or alcohol -intoxicated state.

Student/Professional Code of Ethics:
While in the Bastyr Center for Natural Health, Bastyr University Externship site, or an
approved Preceptorship, the intern clinician’s scope of practice is limited to the scope of
practice of that shift. An intern clinician may not exceed the scope of practice of the
supervising clinician or the scope of practice of the shift in which the care is provided.




                                        Page 100
CODE OF ETHICS: BASTYR CENTER FOR NATURAL HEALTH
Introduction
The purpose of the Code of Ethics is to provide a framework within which all students
and staff at the University’s Natural Health Clinic can learn and work in a safe, nurturing
and supportive environment. Ethical behavior is critical to the quality of interactions
among individuals and groups within the University and Clinic. They also reflect on the
quality of health care given to the patients at the Clinic. We are all striving for
excellence, as individuals, and as an institution, and this Code of Ethics gives us
guidance in seeking that excellence.

1. The Natural Health Care Practitioner’s primary purpose is to restore, maintain and
   optimize health in human beings.

2. The Natural Health Care Practitioner acts to restore, maintain, and optimize health by
   providing individualized care, according to his/her ability and judgment.

3. The Natural Health Care Practitioner shall endeavor to first, do no harm and to
   provide the most effective health care available with the least risk to his/her patients
   at all times.
4. The Natural Health Care Practitioner shall recognize, respect and promote the healing
   power of nature inherent in each human being.

5. The Natural Health Care Practitioner shall strive to identify and remove the causes of
   illness, rather than to merely eliminate or suppress symptoms.

6. The Natural Health Care Practitioner shall educate her/his patients, inspire rational
   hope and encourage self-responsibility for health.

7. The Natural Health Care Practitioner shall treat each person by considering all
   individual health factors and influences.

8. The Natural Health Care Practitioner shall promote personal well-being and the
   prevention of disease for the individual, each community and our world.

9. The Natural Health Care Practitioner shall acknowledge the worth and dignity of
   every person.

10. The Natural Health Care Practitioner shall safeguard the patient’s right to privacy and
    only disclose confidential information when either authorized by the patient or
    mandated by law.

11. The Natural Health Care Practitioner shall act judiciously to protect the patient and
    the public when health care quality and safety are adversely affected by incompetent
    or unethical practice by any person.


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   12.     The Natural Health Care Practitioner shall maintain competence in her/his
   field and strive for professional excellence through assessment of personal
   strengths, limitations and effectiveness and by advancement of professional
   knowledge.

   13.    The Natural Health Care Practitioner shall conduct his/her practice and
   professional activities with honesty, integrity and responsibility for individual
   judgments and actions.

   14.     The Natural Health Care Practitioner shall respect all ethical, qualified
   health care practitioners and cooperate with other health professionals to promote
   health for the individual, the public and the global community.

15. The Natural Health Care Practitioner shall strive to exemplify personal well-
    being, ethical character and trustworthiness as a health care professional.

   (Adapted from the American Association of
   Naturopathic Physicians Code of Ethics)




                                     Page 102
       CLINIC GUIDELINES FOR DRESS, HYGIENE AND GENERAL
       APPEARANCE

1. The purpose of the dress code is to help develop and convey a sense of
   professionalism and to support an attitude of respect toward patients, the clinic and
   our medicine. All medical and clinic staff, and students working when the clinic is
   open need to comply with the dress code. If one is not on duty, but stopping by the
   clinic and not dressed professionally, please make a point of not lingering where
   patients are present.

2. The dress code requires clean, neatly pressed clothing, in good condition, presenting
   a professional attitude about the role that you are performing. Clothes should be
   dressy rather than casual and not revealing. Open-toed sandals or shoes are not
   permitted in the clinic, in compliance with Department of Health regulations.

3. Clothing considered too casual for the clinic includes denim material of any color,
   jeans style pants, athletic footwear, slipper-type footwear, deck shoes without socks,
   T-shirts, polo shirts, tank tops, spaghetti strap sundresses and shirts, sweat shirts,
   sweat pants, and shorts. Undergarments should not show through clothing. If belt
   loops are present, a belt or suspenders are required.

4. Men are required to wear a shift and tie unless they are wearing appropriate apparel
   that does not require a tie. The only allowable exceptions to a shirt and tie are
   turtleneck sweaters, mandarin collared dress shirts, collarless shirts designed to be
   worn without a tie, medical smocks or surgical scrubs (Physical Medicine shifts
   only).

5. Women are required to wear an appropriate top (sweater, blouse, shirt) and bottom
   (dress slacks, pants, skirts, dressy culottes, or dresses). Skirts, dresses and culottes
   must be of modest length. Clothing should never be tight fitting or revealing. An
   appropriate top of modest length must cover tights and leggings.

6. Medical smocks/surgical scrubs are allowable during Physical Medicine shifts.

7. All clinicians in the acupuncture department must wear a white lab coat of knee
   length with lapels over their clothing. This coat must be clean and pressed at all
   times. The student is responsible for his or her own lab coat and its care (washing and
   pressing). It is not permissible to borrow another clinician’s lab coat without
   permission.

8. All Interns must be dressed appropriately for the duration of their entire shift,
   including preview and review.

9. It is preferable that clinicians have no visible piercings or tattoos. However if they do,
   they must be minimal and tasteful. Many patients may find them offensive. Please be
   aware of this.

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10. Please be aware of breath and body odors when at the clinic. Please do not wear
    strong smelling scents, or perfumes in the clinic. Keep hair, beard, and fingernails
    clean and neatly trimmed. Tie or pin back long hair. Hair should not be shocking or
    outrageous in style or color.

11. Be sure to wash your hands between patients.

12. Everyone in the clinic is required to follow the guidelines for Universal Precautions
    for Infectious Diseases, Safety Standards, and Sterile Technique Standards. Please
    review these guidelines, which are located in the Lab. In addition, OSHA-mandated
    education will be required annually in regard to Blood Borne Pathogens. The Clinic
    Infection Control Representative will inform you of the requirements and provide
    opportunities for compliance.

13. NAMETAGS are required while on duty in the clinic and/or at Outreach Events. The
    dress code must be followed when representing the Bastyr Center for Natural Health
    or Bastyr University at Outreach events. Nametags should be ordered in clinic entry
    class.

14. No foods or beverages are to be consumed in the exam rooms.

It is up to each individual to follow this code. It is uncomfortable and unnecessary for
others in clinic to have to remind individuals of the dress code. The Clinical Faculty and
Medical Director will deal with continued and/or flagrant disrespect for each other and
for patients by not following this dress code on a case-by-case basis. Violations of the
dress code may result in the following:

      For the first offense the student will get a written warning. Any Clinical Faculty
       supervisor can write this warning to a student. A copy of this warning will be
       given to the student’s supervisor if a different supervisor wrote it.

      For the second offense, the student will be sent home for the shift, and the student
       will be issued a sanction. The student will lose all hours and patient contacts for
       that day’s shift.

      For the third offense, the student will be sent home for the quarter, fail the shift,
       and the entire shift will need to be made up.




                                         Page 104
IMMUNIZATION POLICY

PURPOSE:
To protect the health and safety of employees and students who may be exposed to
certain biohazard us agents in the campus and clinic-working environment.

TB SCREENING:
 All Clinical Faculty, students and staff who work or take shifts in the BCNH or at an
external shift site are required to be tested for TB annually unless vaccinated. If
vaccinated, students must provide proof of vaccination and provide documentation to the
Safety Officer. If positive TB test occurs without proof of prior immunization, students
must provide documentation of appropriate medically supervised post-test follow-up.
This follow-up is inclusive of a chest radiograph. There are no waivers of this policy.
Employees who do not comply with this policy will be prohibited from working at the
clinic. Students who do not comply will not be allowed to take clinic shifts, or register
for clinic shifts.

Bastyr University agrees to pay for:
100% of the cost of tuberculosis screening for all staff and Clinical Faculty, per
OSHA/WISHA regulations.
50% of the cost of tuberculosis screening for students (up to one half of the amount
charged by the King County Department of Health).

HEPATITIS B IMMUNIZATIONS:
The following occupational positions and student clinicians have been designated as
“exposed individuals” and are required to either take the Hepatitis B immunization series,
provide documentation that they have had such immunizations in the past ten (10) years,
or sign a waiver refusing the immunizations, along with a release of liability form:
All ND and AOM students and clinical Clinical Faculty
All clinic laboratory and operation staff
All employees at the main campus in the following capacities:
Instructor of any class, first aid officer, or any other person whose job may include tasks
involving possible exposure to body fluids/tissues

NOTE: It is not the University’s position to deny anyone from being immunized. Each
person has the opportunity to provide for his or her own immunization. If an employee
believes that he/she is at risk, but is not on the list of at-risk personnel s/he can appeal
that decision to the Campus Safety Officer.

Bastyr University agrees to pay for:
100% of the cost of the immunization series for all staff and Clinical Faculty, per
OSHA/WISHA regulations.
50% of the cost of the immunization series for students (up to one half of the amount
charged by the King County Department of Health).

ALL OTHER REQUIRED IMMUNIZATIONS:

                                         Page 105
For off-site clinic shifts or preceptor sites which require MMR immunization (measles,
mumps, and rubella) or any other kind of immunization or proof of immunity:




The student is required to pay for:
All costs involved in testing for antibody levels, if they choose to check for immunity, as
well as costs for immunizations.

The waiver, commencement of the immunization series, and tuberculosis screening shall
occur before the first day of work for all Clinical Faculty and staff and before ND and
AOM students enter the clinic, and with the start of Fall Quarter each year for entering
ND and AOM students. Screenings shall occur at the campus and clinic. However, the
student may need to receive certain immunizations and screenings off-site on occasion.




                                        Page 106
BASTYR CENTER FOR NATURAL HEATLTH




CLINIC PROCEDURES, POLICIES AND
PROTOCOLS




                Page 107
PATIENT VISIT PROCEDURE

Patient Visit Procedures

Supervising (Attending) Clinical Faculty: Supervisor must personally see each patient, in
the exam room, and participate personally in gathering key subjective information from
the patient and performing key physical exams on the patient at the appropriate time
during each clinic visit. The supervisor must also participate actively in discussing and
making the diagnosis(es) and must direct the treatment plans for each patient. The
supervising (attending) Clinical Faculty is responsible for both the quality of care
provided to each patient and the quality of supervision given to the student clinicians.
Overall case management is the responsibility of the supervising physician. Specifically,
the supervising Clinical Faculty is responsible to:
    a. Preview each case with the students during case preview in order to establish a
        framework from which the students can proceed. Please follow case preview
        guidelines.
    b. Teach the students how to proceed through the standard SOAP format in case
        taking and management.
    c. Actively participate in and approve a diagnostic strategy, being certain that the
        assessment is established before the plan is discussed and/or implemented. The
        primary student clinician should present a differential diagnosis to the supervisor
        with reasons to support and/or rule out each differential diagnosis. The
        supervising Clinical Faculty makes the final decision on the diagnosis.
    d. Decide whether or how much of the case discussion should take place in front of
        the patient or in a private area. When the supervising physician is discussing the
        case with the student clinicians outside the patient’s room, be as timely as
        possible and don’t leave the patient alone for an unreasonable amount of time.
    e. See to it that appropriate referrals take place, either in-house or to an outside
        doctor or facility. There is a referral directory in the clinic Clinical Faculty office
        with a comprehensive listing of referrals. There is also a referral protocol that
        student clinicians and supervising Clinical Faculty should follow.
    f. Actively participate in formulating and then approve the plan of treatment, be sure
        the patient plan and instruction sheets given to the patient are filled out correctly,
        sign the superbill, and sign or initial other appropriate forms such as the
        dispensary order form, lab requisition form and/or record release form.
    g. Go door to door 15 minutes before case review and insure that student clinicians
        are progressing towards completion of the visit.
    h. Approve and/or amend case notes and sign them once the chart is completed and
        signed by the student clinician. Charts should be signed within 72 hours of visit.
    i. In order to demonstrate supervisor faculty involvement in each patient visit, each
        supervising faculty must complete a “Supervising Faculty Comments/summary
        Statements” section at the end of the progress notes for each visit.




                                          Page 108
      j. It must be obvious to any chart reviewer that the supervising faculty has done
         each of the following:
                1. Met each patient and confirmed aspects of the history
                2. Observed and/or repeated any important positive or negative physical
                    exam findings
                3. Confirmed the given diagnoses and assessments
                4. Guided and approved all treatments and follow-up recommendations
     k. The summary must contain the supervising faculty’s comments on the charted
          subjective, objective, assessment and treatment portions of the visit. The
          supervisor comments must indicate active involvement on the part of the
          supervisor and should include some content and brief analysis of each section (S,
          O, A, and P) of the chart notes. The use of “I repeated…”, “I observed…”, “I
          questions…”, “I prescribed…”, “I instructed…”, “I believe…”, are useful
          indicators of supervisor involvement.
     l.   Initial the patient summary line on the inside cover of the chart for each date that
          a patient is seen.
     m. Indicate the approved number of refills for any dispensary items o the dispensary
          order form.
     n. Make sure the superbill is filled out completely: patient name (last name in
          capital letters), date, circle appropriate visit code, diagnosis and diagnostic or
          procedure lab tests, and sign it.
     o. Attend and direct case review at the end of the shift as explained I the
          “Guidelines for student clinician-Clinic Doctors General clinic interaction.”
     p. Initial the student’s summary of patient contact form and time sheet when it is
          completed by the student at the end of the shift.
     q. Delegate responsibility to the primary student clinician as soon and as much as
          possible based on competence and evaluations.
     r.   Give appropriate feedback to students each week regarding their case
          management, using the student daily evaluation form as a guideline. It is
          strongly encouraged to give each primary student weekly written evaluations.
     s. Take attendance on each shift.
     t.   Supervisor must be present in the exam room during all male/female genital
          exams or treatments that expose these areas. Supervisor must ensure accuracy of
          all abnormal physical exam findings.
     u. Supervisor needs to take an active role in communicating difficult or potentially
          life-threatening news to a patient and should not delegate this task to student
          clinicians.
     v. Patients are to remain under the care of the supervisor from quarter to quarter
          rather than to follow the students. In rare cases, exceptions may be made by the
          supervisor.

2.    AOM/ND/Nutrition Primary/Intern Student Clinician
      The primary student intern is responsible for presenting her/his cases in case preview
      and review, directing patient interview, taking the case notes and assessing the
      patient both subjectively and objectively. After collecting this information, the

                                          Page 109
student meets with the supervising doctor to discuss the diagnostic strategy and, once
a diagnosis is reached, establish the plan. The primary student intern is encouraged
to think through and develop her/his own strategy and management of the case. The
supervising Clinical Faculty makes the final decisions. Specifically, the primary
student intern:

a. Previews the case with the attending clinical faculty member and secondary
   student clinician during case preview before initiating contact with the patient.
b. It is the responsibility of the primary intern to physically check the reception area
   for the first 15 minutes of a scheduled appointment in the event of a late patient.
   If a patient arrives more than 20 minutes late for their appointment, the
   receptionist will page the supervisor. The supervisor will determine the viability
   of starting the appointment or the need to reschedule the appointment.
c. Meets the patient in the reception area and shows the patient to the exam room.
   She/he should explain to a new patient how our clinic operates and how patient
   visits are conducted, and tell the patient how many supervisors and/or observers
   will be attending the visit. (From this point onward, the patient is not to be left
   unattended, except for the purpose of providing privacy during disrobing and
   dressing again in connection with a physical exam, or when the student clinicians
   and supervisor discuss the case in private consultation.) Make sure to tell all
   patients to wait until the clinician returns before getting up onto the
   exam/massage table. Additionally, do not leave patients with limited physical or
   mental capacities unattended for more than brief periods of time.
d. Takes case notes in black pen only, neatly and in an organized manner, following
   the standard SOAP formats. An S, O, A or P should be written in for each
   appropriate section on Progress Form.
e. Carries out supervisor’s instructions with respect to interviewing the patient,
   performing a physical exam, diagnostic studies, and making referrals and
   treatment plans.
f. Familiarizes the secondary student clinician with her/his style of case
   management, and directs/supports the secondary student clinician’s role as an
   observer and facilitator.
g. Signs the chart when it is completed (charts must be completed within 24 hours
   of the patient visit), fills in the summary of patient contact Health Data and
   Medication List forms on the inside cover of the chart, makes certain that the
   superbill is filled in correctly and signed by the supervising doctor and obtains
   the supervisor’s signature on the case notes.
h. Is responsible for recommending that the patient is rescheduled at a time that the
   supervisor and, if possible, the primary and/or secondary student clinicians are
   present. The supervisor, with the knowledge and consent of the patient must
   approve exceptions.
i. Is responsible for follow-up telephone contact with the patient, and phoning the
   patient when there is a cancellation or no-show on a scheduled visit, with the
   goal of finding out why the patient was unable to come in, the state of their
   health and to reschedule an appointment. Limit the length of all phone calls
   to/from patients to no more than 3 minutes. All phone contacts need to be pre-

                                    Page 110
         approved by the supervising Clinical Faculty. Be certain to record any phone
         contact information in the patient chart, and have it signed by the supervising
         Clinical Faculty. (Patients appreciate your personal care and the interest you
         show in their health care.)
    j.   At the end of the shift, is responsible for having the time sheet and summary of
         patient contacts signed off by the supervisor/Clinical Faculty.
    k.   Personally locate and inform the supervising Clinical Faculty if they do not
         respond in a timely fashion.
    l.   Remember to close the blinds when a patient is told to undress and put on a
         gown during a physical exam or in certain treatments, and during evening clinic
         shifts.
    m.   Become familiar with clinic resources, such as patient protocols, therapeutic
         notebooks, forms, etc.
    n.   Only practice modalities in which coursework has been completed, and which
         your supervisor has approved (i.e., utilizing cranial sacral therapy should only
         occur on shifts when the supervisor is also proficient).


ND/AOM/Nutrition Secondary/Observer Student Clinician
The secondary student clinician has an observer/facilitator role. It is her/his
responsibility to discuss with the primary student intern on each shift exactly what role
she/he is to take during the patient visit. Specifically, the secondary student clinician:

  a. Becomes familiar with each case on each shift before case preview.
  b. Makes certain that the exam room is in order and that all the necessary supplies are
     in the room. There is a list of supplies for each room in the cabinet above the sink.
     Insures that the paging telephone volume is at an audible level.
  c. Attends case preview to provide input on each case with the primary student intern
     and supervising Clinical Faculty.
  d. Oversees the dispensary care, entering all dispensary items on the dispensary
     requisition form on a one-item-per-line basis. She/he then obtains all appropriate
     supervisor’s initials on the card, seeing that the date, item and refill section are
     complete. This student also takes the form to the appropriate dispensary.
  e. At the conclusion to the office visit, accompanies the patient to the front desk to
     have the return office visit scheduled, and check out. The student does not need to
     wait with the patient.
  f. Instructs the patient that they will have to collect and pay for their dispensary items
     separately from the visit fees. The student should also direct the patient to the
     dispensary.
  g. Makes certain that the room is in order and the supplies that were used replaced at
     the end of the shift.
  h. Attends case review during the last half-hour of the shift.
  i. At the end of the shift, is responsible for having the time sheet and summary of
     patient contacts signed off by the supervising acupuncturist/Clinical Faculty.
  j. Anticipates the paper work that will be needed on a shift and have it ready: release
     of records, diet diary, clinic referral form, etc.

                                         Page 111
   k. Completes all information on the Records Release Form, has patient sign and date
      the form and has the name of the requesting primary intern on the form.
   l. Personally takes the patient’s chart to the reception desk of a different department if
      the patient is subsequently scheduled for a visit in that department.
   m. No treatment modality may be applied to the patient, or patient instruction given to
      the patient without the prior approval of the Supervisor.



4. Time Management
   a. Student clinicians are responsible for beginning and ending patient visits on time.

  b.   An extended FOC is 1.5 hours, of which 1.25 hours is for the patient visit and 15
       minutes is for completing the chart and preparing for the next patient. You should
       manage your time appropriately. Homeopathy FOC’s are 2 hours. Nutrition FOC’s
       are 1 hour.

  c.   An acute FOC is 1 hour, of which 45 minutes is for the patient visit, and 15
       minutes is for completing the chart and preparing for the next patient.

  d.   A regular ROC is 1 hour, of which 45 minutes is for the patient visit and 15
       minutes is for completing the chart and preparing for the next patient.

  e.   An acute ROC is for 30 minutes, of which 20 minutes is for the patient visit with
       10 minutes used for completing the chart. The purpose of this visit is for follow-up
       on 1 acute health concern.

  f.   “Introduction Visit” (Consult) is for 20 minutes. The purpose of this visit is to
       answer patient questions and provide general information. No diagnosis or
       treatment is to be given.

  g.   As each patient visit is completed, the exam room is to be disinfected, organized,
       and made ready for the next patient.

  h.   Time should be managed so that the student clinicians are done and are ready for
       case review for the last 30 minutes of the shift.

  i.   Students cannot determine the length of a visit. This is the responsibility of the
       supervising doctor. When a patient schedules and is seen for a visit, the length of
       the visit should not be changed without the supervisor’s consent.

 5. Check-out with Payment for Services
  a. When the patient visit is completed, the primary or secondary student clinician
      must accompany the patient to the front desk for rescheduling and check-out. Be
      sure to hand the front desk staff the completed and signed superbill. The
      supervising physician is responsible for filling out the superbill accurately and

                                         Page 112
     completely, with all diagnostic, treatment code numbers as appropriate. Students
     should not linger at the front desk and only wait there if assistance is required for
     patients with a special scheduling need.

b.   All patients must check out at the front desk before leaving the clinic. Secondary
     clinicians are responsible for notifying the front desk of any late patient checkouts.

c.   The patient services department, prior to the patient visit, must arrange all payment
     arrangements, or discounts on services. Students must not discuss fees or payment
     arrangements wit patients.

d.   Be familiar with the scope of clinic services.




                                        Page 113
PATIENT RECORDS AND RELATED FORMS

Following is a list of forms that you should become familiar with and use in the clinic. If
you have questions about these forms, please contact the Clinic registration staff or Clinic
Program Coordinator:
Comprehensive FOC Case History Interview Form
Progress Notes Form
Physical Exam Form
Patient Summary Form in Chart
Medication Log form
Patient Information Form
Adult Health Data Form
Pediatric Health Data Form
Dispensary Order Form
Lab Requisition Forms (In-House and Reference Lab)
Patient Plans and Instructions Form
Summary of Patient Contacts Form
Reportable Disease Form
Preceptor Program Forms
Clinic Outreach/Community Education Form
Interim Hour Form
Substitute/Absence Form
Advising Form
Clinical Faculty/Clinical Faculty Evaluation Scantron Card/Form
Referral Letter Samples
Request for Patient Records Form
Diet Diary Form
Student Report to Medical Director Form
Patient Profile Form
Consultation Interview Form
Time Sheets
Life Contract
Naturopathic Welcome Information
Observation Consent Form
Informed Consent 1 and 2
New Patient Information Form
Naturopathic Treatment of Malignancy
Interpreter guidelines
Ossious manipulation screening questionnaire
Referral forms (templates)




                                        Page 114
PATIENT CHARTS

PATIENT CHARTS ARE TO REMAIN IN THE CLINIC AT ALL TIMES. UNDER
NO CIRCUMSTANCES ARE PATIENT CHARTS EVER TO LEAVE THE CLINIC.

1. When a chart is removed from the front desk area, an out card must be filled out and
put in the chart’s place. Do not re-file charts that have been removed from the files.
Place the charts in the chart return box, if completed and signed, and the front desk staff
will refile them. If incomplete or needing supervisor signatures, complete a Patient Chart
Requires Action notice and place this notice in the supervisors mailbox. The incomplete
chart must be returned to the chart room while it is not being used or completed by the
clinician. Attach an Incomplete chart tag inside the front cover and place in supervisors
chart box. All charts must be completed within 24 hours of the contact. Supervisors
must sign these within another 48 hours. Please refer to the guidelines around front desk
function and student’s responsibilities when interacting with the front desk. (See chart
guidelines at front desk for more information.)

2. If a student clinician removes a chart from the Bastyr Center for Natural Health
premises:

 a. On first offense, it will result in a failure in clinic for one entire quarter shift,
 including loss of hours and patient contacts.

 b. On second offense, it will result in a second clinic shift failure and immediate clinic
 suspension.

3. There are several basic chart components to each patient’s chart, (and correct
placement in chart):
 a. Patient in-take form (last page on inside front cover)
 b. Case history/physical exam/assessment/plan forms (filed in chronological order,
      most recent on top)
 c. Progress notes (filed in chronological order)
 d. Copy of Plans and Instructions (ND) to patients (filed with notes from that day’s
      visit)
 e. Lab reports (back section, on left)
 f. Previous medical records and copies of release forms (back section on right)
 g. Patient Summary Sheet (first page on inside front cover)
 h. Adult or Pediatric Health Data Form (inside front cover)
 i. Statement and Insurance Form (superbill - placed inside of chart prior to each
      visit)
 j. Patient information form (inside left front cover directly beneath medication log
      form)
 k. Medication Log form (inside left front cover, on top of Patient information form)
 l. Referral form (when current, it supercedes all other forms on top of inside front
      cover)


                                           Page 115
4. Each component of the chart is the responsibility of one or more members of the
patient-care team: supervising physician/Clinical Faculty, primary student clinician,
secondary student clinician. The responsibility of keeping the charts in order belongs to
the primary student clinician:
  a. The patient summary sheet will be fixed as the first page on the left inside cover of
      the chart. The sheet will contain an entry for each visit that should be filled out
      correctly and initialed by the supervising physician/Clinical Faculty.

 b.   Lab reports are to be 2-hole punched at the top and inserted into the back section of
      the chart, on the left.

 c.   The patient intake form will be 2-hole punched at the top and inserted as the last
      page in the front section of the chart under the patient summary sheet.

 d.   The FOC forms will be 2-hole punched at the top and inserted in the front section
      of the chart, opposite the intake form.

 e.   The Adult Health Data form will be 2-hole punched and placed inside left cover.

 f.   The Patient Information form will be 2-hole punched and placed inside left cover.

 g.   The Medication form will be 2-hole punched and placed on top of the Patient
      information form.

 h.   Progress notes for each succeeding ROC will be 2-hole punched at the top and
      inserted on top of the previous visit notes.

 i.   Previous medical records should be 2-hole punched at the top and inserted in the
      back section of the chart opposite the lab reports in order received.

 j.   Notes/letters from referral physicians should be 2-hole punched at the top and
      inserted as they are received as previous medical records and behind FOC forms.

 k.   Referral letter when current; it supersedes all other forms on top of inside front
      cover.

 l.   All charts must be completed by the primary student clinician in 24 hours and
      signed by the supervising physician within 72 hours after the patient contact.



5.    Charting concerns and/or deficits identified should be discussed by the supervising
      physician/Clinical Faculty and student, and corrected immediately. If this doesn’t
      resolve the problem, the student will be warned in writing of the problem and asked
      to correct it within a defined time limit. If chart is not corrected within that time,
      the student will receive a clinic sanction.

                                         Page 116
CHARTING GUIDELINES

ND CLINIC:

1. All chart entries must be make in black ink on the appropriate form [see Progress
Notes, Appendix 5]. Do not use ink colors other than black. Do not use pencils or
erasable ink. Computerized chart notes must be done on clinic read-only templates
installed on clinic library computers. Charting may not be done on personal computers
or PDA’s. This policy is to protect the confidentiality of our patients.

2. All charting corrections or changes made by a student or supervising faculty in a chart
on the day of the original entry are to be made as follows:

 a.   Draw one line through the entry to be changed.
 b.   Write the new entry next to the old entry.
 c.   Initial the change.
 d.   Please refer to the Medical Abbreviations list in Appendix 6, for approved medical
      abbreviations in charting.

3. For all chart changes made in a chart after the day of the original entry by the
supervising faculty:

 a.   Draw one line through the entry to be changed.
 b.   Write the new entry next to the old entry.
 c.   Initial and date the change.
 d.   No changes can be made after the provider has signed the chart.

4. No patient may be treated without the following:

 a.   A 'consent to treatment' form signed by the patient of the patients designated
      signatory.
 b.   A completed patient intake form and patient billing/insurance form


ACUPUNCTURE CLINIC:

1. Each treatment episode is charted in the form of “SOAP” notes.

 a.   S: Subjective findings, the chief complaint and history portion of the treatment
      episode.
 b.   O: Objective findings, the observation of tongue and pulse, as well as other
      observation, orthopedic tests and palpation
 c.   A: Assessment, the diagnosis, change in status, or other conclusions.
 d.   P: Plan, treatment principle, acupuncture prescription, herbal formulas, other
      modalities used, referrals made to other providers and patient instructions


                                         Page 117
2. All acupuncture prescriptions should include points needled, type of needled used and
any special technique.

3. When electro-stimulation is provided, the chart notes should include which points
were stimulated in the format of from point A to point B, what mode was used
[continuous, discontinuous, mixed], what frequency was used in Hertz. Where the
frequency was mixed, both frequencies should be noted.

4. When moxibustion is used, the location, type of moxibustion and duration should be
noted.

5. When cupping is part of the treatment, the location of the cupping and whether
walking cups were used should be noted.

6. When acupressure is used, the location and type of procedure should be noted.

7. Any additional procedure, such as tui na, or gau sa, must be charted in the plan section
of the chart notes.

8. No mark or designation reflecting the nature of the diagnosis may appear on the
outside of the chart.




                                        Page 118
Naturopathic Clinic

CHARTING

SOAP FORMAT:
Case Taking and Charting
Note that within the SOAP format there are variable styles of charting.

1. Each chart should have a subjective (S), Objective (O), Assessment (A) including
   therapeutic order, Plan (P), Future Plan (FP) and Impression (I).

2. The primary student clinician is responsible for signing the chart before giving it to
   the supervising Clinical Faculty for review and signature. Each chart should be
   returned to the chart room and a chart review form placed in the supervisor's clinic
   mailbox to alert them to the need for review and signature of the chart. (Note that
   within the SOAP format there are variable styles of charting.)

3. Charts need to be clear and concise. The S, O, A, etc., need to be clearly written out
   in legible writing. A new CC should have all 7 attributes, as appropriate. Old
   complaints need documentation of what has changed or is different. At each visit, the
   student should ask what medications/supplements patients are taking or if they are
   taking what has previously been prescribed. If a patient discontinues a
   medication/supplement, is should be noted in the medication/supplement sheet on the
   left of the chart.

4. Spelling should be accurate.

5. All paperwork must be filled out in its entirety before turning in the chart to the
   supervisor for their signature. This includes the chart notes with the patients name,
   date, supervisors full name and your full name on every page, treatment plan for
   patient, patient visit summary, with correct ICD 9 code/s, medication/supplement
   sheet filled out completely with dosing schedule and ordering doctor, even if it is self
   prescribed, adult health data sheet or pediatric health data sheet with patients data,
   their PCP or specialists with addresses, phone numbers and drug allergies. Treatment
   plans in the chart must include dose in terms of mg/grams/etc., not just 3 caps TID,
   unless it is a multivitamin or combination product, and also a brief rationale of why
   the student has chosen those specific therapeutics.

6. Do not leave any preparation notes in the chart. If the student has done preparatory
   work, the student must keep that information.

7. All of the documentation must be completed within the borders of the chart.
   Anything outside of those borders, i.e. the dark thick line, may not be copied when
   medical records are requested from another provider. This includes S, O, etc., and
   signatures.

                                        Page 119
8. Charts must be completed and signed by the student within 24 hours after the visit.
   Once the chart is completed, the student must fill out a chart action review form for
   their supervising faculty. The completed chart must be returned to the chart room
   behind the main reception desk when not in use.

9. Assessment: The Assessment is perhaps the most important part of the chart.
   Assessment may be as simple as stating the Diagnosis(es), when the clinician is
   certain of the patient’s specific disease entity. You may consider your diagnosis
   likely but not certain, in which case you should precede the stated diagnosis with an
   indicative term such as “working” diagnosis, “presumptive” or “probable” diagnosis.
   In this event, your Assessment will also include Rule/Out(s) or a Differential
   Diagnosis, for example: “Probable Diagnosis: Atypical Migraine Headache, Rule/Out
   increased intra-ocular pressure.” To the extent that you know it, record your
   diagnostic rationale after each Diagnosis or tentative Diagnosis. All active diagnoses
   that are addressed in any way at a given encounter, with a correct ICD9 code for
   each, must be recorded in the Assessment section, corresponding exactly with the
   correct diagnoses that are recorded on the superbill. This account will be brief when
   charting the evaluation and management of an independent, self-limited, acute
   problem, and complex when managing a complex encounter. Remember that every
   stated Rule/Out or Diagnosis requires a corresponding action in the Plan for that day
   intended to accomplish the Rule/Out or address the Diagnosis (even if the action is
   only to watch and wait), whereas Differential Diagnoses may have but do not demand
   an action that addresses them in that day’s Plan. Finally, all active or resolved
   Diagnoses and Problems are recorded and tracked on the patient’s Health Data Sheet,
   which appears on the left side of the front section of the patient’s chart.

10. Problems: Different definitions of patient Problems in the outpatient setting, and
    their use in patient Assessment and management, have been described since this
    convention began in the 1960s. At BCNH, we refer to the system designed for use in
    family practice as described by Rakel (Essentials of Family Practice, 1998, pp.96-97).
    Rakel defines a Problem as “anything that requires diagnosis or management or that
    interferes with quality of life as perceived by the patient. It is any physiologic,
    pathologic, psychological, or social item of concern to either the patient or the
    physician.” Rakel delineates further that a Problem can be anatomic (hernia),
    physiologic (undiagnosed jaundice), a specific diagnosis, a sign, a symptom,
    economic (financial stress), social (family discord), psychiatric, a physical handicap,
    an abnormal lab or imaging finding, or a risk factor (personal or family). Note that
    “Problem” is a more inclusive, and often less conclusive, term than “Diagnosis.” A
    Diagnosis communicates the provider’s certainty of the existence of a specific disease
    entity. A Problem can be a Diagnosis, or it can be a variety of assessments in
    progress, some requiring further evaluation. Note that a Problem or a tentative or
    “working” Diagnosis, because they are still works in progress, often require an
    attached Differential Diagnosis, whereas a Diagnosis never has an attached Ddx. For
    example, “Problem: Lower Left Quadrant Pain, Ddx. constipation, IBS.”


                                        Page 120
    a. If the purpose of the charted visit was to follow-up on a previously listed
       problem from a Problem List, and the Problem has resolved by inclusion in
       another Diagnosis, or by cure or disappearance, this should be noted in your
       Assessment. Remember that each active (addressed that day) Diagnosis,
       Problem, or Rule/Out demands corresponding action be noted in the Plan section
       that is followed-up at a time interval stated in the Plan. Differential Diagnoses,
       listed as an attachment to a Problem or a tentative diagnosis, do not demand that
       corresponding action be described in that day’s medical record.

    b. Example: In the Assessment section of the patient’s chart, the charting provider
       can choose to identify a single Diagnosis or Problem, or several of them, and can
       choose to identify them by either title as appropriate, recording them in a list
       fashion if there are several. Please do not confuse this list presentation of
       multiple Diagnoses or Problems with the patient’s Problem List. The latter,
       appearing on the patient’s Health Data Sheet, is a complete listing of all the
       patient’s Problems, active and resolved, past and present. The Problems and
       Diagnoses that appear in the patient’s daily chart are only (and all of) those that
       were actively evaluated or managed that day. An Assessment might look like
       this:

    c. Assessment: (Rationale or Ddx)
    Diagnoses: GERD—Rationale: secondary to suspected food
    intolerance and possible weak gastric muscle tone and reduced
    HCl/pepsin production

    Problems: headache—Ddx: atypical migraine, chronic sinus infection,
    eyestrain

11. Impression: After you indicate your active Diagnoses and Problems, you may then,
in your own words, give your Impression of the patient. Remember to write this section
professionally and respectfully.

12. Plan: All actions recommended or prescribed at the present patient visit must be
noted in complete and pertinent detail in the Plan section of the patient’s chart. These
will include instructions for diet or lifestyle modification or intervention; any medication
(herbal/botanical, homeopathic, neutraceutical, or prescription medication) with complete
and correct name of product, key ingredients(s) as appropriate, # of units, dose and
instructions, duration of dosing, and important side effects about which the patient was
informed and what they were instructed to do if they occur; therapeutic application or
self-treatment (with detailed instructions); discussion of important side effects about
which the patient was informed and what they were instructed to do if they occur;
referrals for treatment; consultations with specialists; and laboratory testing or imaging.
Remember that the Plan must contain an action corresponding to every Problem,
Diagnosis, or Rule/Out evaluated or managed at that visit, even if the action is simply to
watch and wait (do nothing).


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a. As you create and record this Plan, consider the Hierarchy of Therapeutics
   (Therapeutic Order) and Naturopathic Principles, and how these principles have
   guided your Plan. Note these thoughts in careful detail in the Plan section of the
   chart.

b. The Plan section, often charted as “Future Plan,” should also include all of your
   future planned actions for yourself and your team, including any intended follow-
   up, when you will next see the patient in the clinic, any planned phone calls to
   the patient, referral research activities, and coordination of care.




                                   Page 122
 NEW SUPERBILL INSTRUCTIONS FOR FACULTY AND STUDENTS

Listed below are the superbill fields that need to be completed or reviewed by
students and/or supervisors for each patient visit.

1. Provider Name: Clearly print the name of the supervising provider. No
   signature is required on the superbill.

2. License #: Clearly print the license number of the supervising provider.

3. Department: Circle the department and/or program in which the patient will be
   seen.

4. Patient Information: The front office staff may have already completed this
   information. Make sure that the completed information is correct and fill in any
   missing fields.
       a. Name: Patient name should be printed legibly.
       b. Date of Birth: Verify that the date of birth written on the superbill
          matches the date of birth on the patient’s chart.
       c. Date of Service: Verify that the date of service is correct.

5. ICD-9 Codes: List each ICD-9 code in descending of priority or relevance by
   which it relates to the chief presenting illness. Only list 4 diagnoses on the
   superbill even if the chart notes indicate more than 4 diagnoses. A list of
   diagnoses with ICD-9 codes is located on the back of the superbill. If a diagnosis
   is not listed on the back of the superbill, you will need to consult a current ICD-9
   book to find the correct code. The Business Office staff is available to help you
   determine the correct codes and to answer your coding questions.

6. CPT Codes: Circle all procedures that were performed during the visit. In the
   column labeled “Dx#” indicate the associated diagnosis (1, 2, 3, or 4). As above
   in #5, only one Dx# per CPT even if more than one diagnosis relates to the
   procedure. The Dx# should indicate only the diagnosis that is the most
   significant to the service performed. There may be additional diagnoses listed
   above that are not tied to a procedure.




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INTERVIEW GUIDELINES

Primary ND Clinician

1. The student needs to direct the interview. While it is important to hear the patient’s
   story, it is also inefficient to let the patient take over the interview. If a patient seems
   like they are not answering your questions, then politely interrupt them and help
   focus them. This may mean that you do this several times during an interview, but
   you will gain more information in the end.

2. Remember that FOCs are actually 75 minutes and ROC’s are 45 minutes. This
   means the interview for an FOC should generally be no longer than 45 minutes and
   ROC’s no more than 20 minutes. You need to leave time to do PE, formulate your
   diagnosis and treatment plan, discuss the treatment plan and then present it to the
   patient.

3. It is important not to feel compelled to obtain all of the patient's information in one
   visit. If the patient has a complicated history, let them know up front that another
   visit may be required in order to obtain the full picture. It is important, however, that
   their main complaint is addressed in the first visit.

4. Never discuss any treatment with a patient during the interview without consulting
   the supervising clinical faculty member first.

Secondary ND Clinician

1. You are there to support the primary clinician in directing the interview. The
   expectation is that you will assist the primary in maintaining good flow throughout
   the interview, without being disruptive. It is important for you to be involved with
   the interview process without undermining your primary. Ask questions when it is
   appropriate and help fill in gaps that may have been overlooked by the primary.

2. Remember, FOC’s are actually 75 minutes and ROC’S are 45 minutes. This means
   that the interview for FOC should generally be no more than 45 minutes and ROC’s
   no more than 20 minutes. You need to leave time to do PE, formulate a diagnosis
   and treatment plan, discuss the treatment plan and then present it to the patient. It is
   also your responsibility to help keep the interview on track.

3. It is important to not feel compelled to get all of the patient's information in one visit.
   If the patient has a complicated history, let them know up front that another visit may
   be required in order to obtain the full picture. It is important, however, that their
   main complaint is addressed in the first visit.

4. Never discuss any treatment with a patient during the interview without consulting
   the supervising clinical faculty member first.

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5. You are responsible for all the patients’ paperwork, including the superbill, treatment
   plan and dispensary sheet. You should keep blank copies of these with you before
   the shift so they are available when necessary. Each piece of paper should be filled
   out in its entirety and accurately. Treatment plans should be legible, with each
   provider’s full name and a rationale for each treatment recommended. It is important
   for patient compliance to write a good rationale for each treatment so the patients
   fully understand why they are following a particular regimen.


PHYSICAL EXAM GUIDELINES

1. You are expected to know every physical exam you have learned to date. Your
   Physical/Clinical Diagnosis class has taught you most of what you need to know to
   perform a thorough PE. This includes orthopedic exams, PAP, gynecological and
   prostrate exams, etc. Even if you haven’t done one in a long time or ever, you should
   still be familiar with the technique and appropriate steps in performing that exam.

2. Vitals need to be taken at each visit, including Physical Medicine shifts. Height and
   weight should be taken as well.

3. Your equipment should be with you for each shift and in working order. You should
   be checking it the day before to ensure that everything works well, batteries are
   recharged, etc.

4. A doctor must be present in the room during a rectal or genital exam. This is for your
   legal protection as well as making sure the exam is done correctly. If a gynecological
   exam is being performed, make sure a female is present in the room if at all possible.

5. Anticipate the exam that might be performed and have your equipment ready. This
   will streamline your time management.

6. Alert your supervisor of all questionable or abnormal findings. Always ask when
   needed. The attending physician must recheck all positive findings.


SHIFT GUIDELINES FOR ND PATIENT CARE and AOM OBSERVATION AND
INTERN SHIFTS
1. Clinical Faculty will take attendance at case preview and review of each shift.
   a. If a student is 15 minutes late for either preview or review, she/he will be marked
      absent for that 30 minutes, and will need to make up that time.
   b. If a student misses case preview, she/he will be marked absent for the entire 4-
      hour shift, and that time will need to be made up.
   c. If a student is absent less than15 minutes, the equivalent time will be deducted
      from their clinic time sheet.


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2.   Students are responsible for having their Time Sheet at each shift.
     a. Four hours is the maximum that can be counted on each shift.
     b. Students need to have the supervising doctor/Clinical Faculty initial the Time
        Sheet each week.
     c. Any time missed on a shift due to absence, lateness, or holiday will result in an
        IP for the shift as incomplete hours. These hours will be made up with
        substitution at extra hours.

3.   Students are required to keep a summary of patient contacts from all shifts, interim
     clinic and sub and extra time. These are to be recorded on the Summary of Patient
     Contacts Form, and each patient contact must be initialed by the supervising
     doctor/Clinical Faculty directly involved with each patient. ND and Nutrition:
     Must designate each contact as either Primary (P) or Secondary (S). AOM: Must
     designate each contact as either FPI or SPI.

4.   Hours lost due to absences, snow days or holidays need to be made up at some point
     before graduation. 100% of program hour requirements need to be completed.

5.   ND, Nutrition and AOM: At least 80% attendance is required to receive a grade of
     IP (in progress) which will convert after missed hours are made up to achieved
     competency for each quarterly shift (holidays and emergency closures excluded).
     Two excused absences per shift are allowed. Three excused absences for an IP grade
     may be allowed under special circumstances at the discretion of the supervisor,
     otherwise the student will receive an F grade for the shift. Four or more absences
     will result in a failure for the shift, with loss of all hours and patient contacts. An
     excused absence is an absence for which the student has properly filled out and
     returned all required paperwork in a timely manner. Note that an excused absence
     requires that a clinician identify and confirm a student substitute. (See absence
     policies.)

6.   An unexcused absence is defined as not being on a scheduled shift and failing to
     notify the scheduled supervising clinical faculty member of your absence prior to
     the start of the shift. The first unexcused absence during a term will result in the
     student clinician being required to complete three shifts [12 hours]. A second
     unexcused absence will result in the loss of the entire shift. The supervising clinical
     faculty member may, at their discretion, accept notification of an absence after the
     start of the clinic shift in the event of an extraordinary emergency. Even if the
     student calls the supervisory clinical faculty member prior to the missed shift, the
     supervisor reserves the right to define the missed shift as an unexcused absence and
     sanction the student accordingly. This would occur if, in the estimation of the
     supervisor, the reason for the student's absence does not warrant missing the shift.


7.   Students must complete chart notes for all patient visits and phone contacts within
     24 hours of the contact. Incomplete charts must be appropriately labeled and notes
     and treatment plan from the visit must be in the chart. These charts must remain in

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     the clinic at all times and are left in the supervising Clinical Faculty’s “chart box”.
     Violation of this policy will result in a clinic sanction, resulting in loss of that day's
     shift hours and patient contacts. Repeated violations of this policy will result in a
     failure of the entire quarterly shift. (Including loss of those shift hours, and patient
     contacts).

8.   Students should become familiar with Section on Lab and the Section on
     Dispensary in the Clinic Handbook. The charts are left by the student behind the
     front desk in designated chart return area. The charts are refilled by the front desk
     in the chart room. The student must complete a chart review notice for each chart to
     their supervisor alerting the supervisor to review and sign the completed chart.
     These notices must be placed in the supervisor's clinic mailbox.




                                          Page 127
AOM/ND/NUTRITION CASE PREVIEW PROTOCOL

The following are recommendations to make case preview a better learning and teaching
experience:

1.   Case preview is the first 30 minutes of each 4-hour shift.

2.   Start promptly. Clinic supervising Clinical Faculty is responsible for starting and
     ending case preview on time. Clinic supervisors should be familiar with the day’s
     cases.

3.   Students should be prepared to start on time with all of their cases reviewed
     beforehand. All lab work and medical records should be in the chart ready to be
     discussed.

4.    Each student team from each room presents a brief identification of their patients
      scheduled on the shift, with their chief complaints.
     a. Patient age, sex and race if relevant.
     b. Chief complaint(s).

5.   Then, going one room at a time, the primary student clinician should present the
     reason or purpose of the days’ visit for each of the patients in their room. The
     clinician should include other relevant information on each case, namely age of
     patient, sex, race and chief complaints.

6.   If this is a ROC, a short summary should be presented of past data pertinent to
     understanding the differential diagnosis, and the response of the patient to the
     treatment. Also note future plans. A discussion of that day’s plan should be
     presented.

7.   If this is an FOC, a discussion of the complaint listed should occur that includes
     possible diagnosis, confirmatory exams, and therapeutic ideas.

8.   All the other student clinicians should be attentive to each case, in order to learn
     from it and offer any input they might have.

9.   By the end of case preview, all the cases will have been discussed as a group, and
     the students prepared to start the first scheduled patient’s care.

10. If students are more than 15 minutes late for case preview without prior arrangement
    or an emergency, there will be no credit given for case preview, and the 30 minutes
    time will need to be made up at a future date. Shift supervisor will mark absent on
    the CP (case preview) section of the attendance sheet for that shift.




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11. This is valuable time that should be used to prepare and educate the supervising
    physician/Clinical Faculty and student clinicians for the shift’s patients.

12. Finish case preview with the group after 25 minutes, to allow 5 minutes for students
    to get ready to start on time with their patients, and time to discuss cases on an
    individual basis if needed.


AOM/ND/NUTRITION AND AOM CASE REVIEW PROTOCOL
[YOUR CASE PRESENTATION MUST BE CONCISE AND TO THE POINT.
THIS SHOULD BE DONE IN 6 TO 7 MINUTES.]

1.   Clinic supervising physicians/Clinical Faculty is responsible for starting and ending
     case review on time.
2.   Case review is the last 30 minutes of the 4-hour shift.
3.   Any student more than 15 minutes late for case review will not receive credit for
     case review. (You must get approval from the supervising physician/Clinical
     Faculty in order to get credit under special circumstances.) The 30 minutes will
     need to be made up to receive credit.
4.   At the beginning, student clinicians from each room will report briefly on each
     patient identifying the chief complaints and the diagnosis.
5.   Supervising physicians/Clinical Faculty will then choose the best teaching cases and
     have the student clinicians present each case with the following format: (NOTE:
     Students are encouraged to present their cases from memory without reading
     excessively from the patient’s chart.)

SUBJECTIVE
 1. Patient information
 2. Introductory comment
 3. Chief complaint(s) and its (their) duration
 4. HPI- present a succinct version of the HPI
 5. Pertinent positive findings from appropriate ROS section(s)
 6. Pertinent risk factors and family history
 7. PMH - give only pertinent information
 8. Allergies - all allergies including drug reactions (include type of reaction)
 9. Medications - all present medicines, dosages and indications for taking
 10. Lifestyle - pertinent information on work, school, home environment, sleep,
     exercise, diet, relationships, habits
 11. ROS - state only pertinent positives (other than those mentioned in HPI)




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OBJECTIVE

Physical Examination
1. Introductory sentence - describe appearance and condition
2. Vital signs
3. Pertinent positive findings - describe findings

Laboratory Tests and Diagnostic Studies
1. State pertinent positives and significant findings
2. State pertinent negatives if they are significant
3. State significant past results, if available

ASSESSMENT
Problems and Diagnoses, Differential Diagnosis and Rule/Outs.


PLAN
Treatment recommendations, philosophical principles employed, future plans and
expected outcomes should be summarized.

PATIENT MANAGEMENT POLICIES

MEDICAL RECORDS
All medical records requested and/or received must be processed via the medical
records department.

1.   Please tell patients who want records of their charts sent to another health care
     practitioner, or to themselves, that the patient must complete a Release of
     Information Form. Only information that originated at BASTYR CENTER FOR
     NATURAL HEALTH will be released and only with signed authorization. There
     may be a charge for patients wanting records for personal use or to hand-carry to
     another provider. There is always a charge to send patient information to parties not
     directly involved in patient care.

2.   Copies of information from other health facilities will not be released to patients.
     They may contact the facility where the information originated.

3.   Copies sent to another clinic/health care practitioners are sent at no charge, as a
     professional courtesy. A patient who wants information for personal use, or to hand
     carry to another provider will be given 15 pages at no charge. Copies in excess of 15
     pages will be charged at the full rate.

4.   All copies sent to parties not directly involved in patient care will be charged at the
     full rate.



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5.   Medical Records Personnel collect completed authorizations for processing. The
     form must be signed and dated by the patient, include the outside facilities address,
     patient date of birth, and patient’s daytime phone number. The student clinician
     should tell the patient that it will take 7 – 10 business days to process the request.
     Outside release forms must include special authorization for information related to
     sexually transmitted diseases, HIV and AIDS, substance abuse or mental health and
     counseling.

6.   When medical records personnel receive information, that information is placed in
     the chart and they are placed in requesting provider’s box.

7.   Medical record personnel must process all outgoing requests and incoming records.
     This includes all records received by FAX. Medical Records must also process any
     information mailed directly to the NHC providers.

8.   If a patient is being seen simultaneously by different providers, it is permissible for
     the Bastyr supervisor/student team to include copies of relevant labs or progress
     notes with written referral letters with a summary of treatment letters to these other
     providers. It is also permissible for these providers to share information from the
     patient records with one another as part of consultation conversations.




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INSURANCE

PROVIDER PARTICIPATION IN THIRD PARTY REIMBURSEMENT
1. The Bastyr Center participates in third party reimbursement systems. All providers
   at the Bastyr Center are required to contract with the health insurance or other
   reimbursing agencies designated by the Bastyr Center, and to timely and fully
   maintain current applications, documentation, current copy of license, etc., and
   contracts with these agencies.

2.   Providers are expected to correctly apply the standard systems of ICD, CPT, and
     Documentation Guidelines for Evaluation and Management Services as agreed upon
     by the World Health Organization, HCFA, and associated medical groups. Salient
     aspects of these systems are outlined in sections that follow.

Current Procedural Terminology (CPT)
1. The Bastyr Clinic uses CPT codes according to the standards agreed upon by HCFA
    and associated medical groups, and relies upon CPT reference texts like the CPT
    2001 AMA to describe these standards. The chosen CPT codes reflect the level of
    care, level of Evaluation and Management Services E/M, at any given patient visit.
    During each patient visit the supervising clinician is responsible for choosing the
    correct CPT code for the visit, and for recording it on the patients billing and lab
    forms.

2.   Important principles for choosing CPT codes include:

           a. A new patient is one who has not received any professional services from
              the clinician or another clinician of the same specialty who belongs to the
              same group practice, within the past three years.

           b. Counseling is defined as a discussion with a patient and/or family
              concerning diagnostic results, impressions or recommendations,
              prognosis, risks evaluation and risk reduction, patient instructions for
              treatment and follow up, importance of compliance, patient and family
              education. Counseling does not include psychotherapy.

           c. Three components of an office visit are key to determining the level of
              E/M service. They are: History, Examination, and Medical Decision
              Making/Complexity.

           d. The quantity of detail, counted as elements, in areas of History of Present
              Illness/Chief Complaint (HPI/CC), Past/Family/Social History (PFSH),
              Review of Systems (ROS), and Physical Examination further impacts the
              level of CPT chosen.



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          e. Time, in reference to a patient visit, equals face-to-face time working with
             the patient.

          f. There are five E/M levels of risk and complexity: Minimal, Self-Limited,
             Low, Moderate, and High.

          g. To select a CPT code for a New Patient Visit, the E/M services provided
             must meet or exceed established criteria in all three key components
             described above. A return office visit must meet or exceed only two, and
             one must be the level of medical decision making/complexity.

          h. In the case where counseling and/or coordination of care constitutes more
             than 50% of the clinician/patient and/or family encounter (face to face
             time), then time alone becomes the determining CPT factor. Quantity
             of time must be documented.

          i. The CPT code series most used at Bastyr Clinic in ND patient care are
             Office or Other Outpatient Services (99201-205, 99221-215), Preventive
             Medicine Services (99381-387, 99391-397), and Counseling and/or Risk
             Reduction Intervention (99401-404).


Documentation Guidelines (DG)

a. The Bastyr Center uses Documentation Guidelines for Evaluation and Management
   Services as agreed upon by HCFA and the AMA. Bastyr Center medical record
   instruments accurately model the principles of these DG, including Bastyr Center
   ROS and PE forms. Summaries of DG appear at corresponding location in these
   instruments for the clinician’s convenience. Clinicians are responsible for ensuring
   that each patient’s medical record at each visit is in compliance with these
   guidelines. Principles for correct medical record keeping according to the
   Documentation Guidelines for Evaluation and Management Services include
   documentation of:

a. Chief Complaint (CC) of complaints

b. History of Present Illness (HPI) including pertinent elements of location, quality,
   severity, duration, timing, context, modifying factors, and associated signs and
   symptoms.

c. Review of Systems (ROS) including pertinent elements of Constitutional symptoms,
   Eyes, Ears/Nose/Mouth/Throat, Cardiovascular, Respiratory, Gastrointestinal,
   Genitourinary, Musculoskeletal, Integumentary (Skin and/or Breast), Neurological,
   Psychiatric, Endocrine, Hematological/Lymphatic, Allergic/Immunologic

d. Pertinent elements of Past, Family, and/or Social History (PFSH).

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e. Pertinent elements of Examination including examinations of Cardiovascular,
   Ears/Nose/Mouth/Throat, Eyes, Genitourinary (Male and Female),
   Hematological/Lymphatic/Immunologic, Musculoskeletal, Neurological, Psychiatric,
   Respiratory, and Skin Organ systems or areas.

f. Pertinent factors of Complexity of Medical Decision Making including Number of
   Diagnoses or Management Options, Amount and/or Complexity of Data to be
   Reviewed, and Risk of Significant Complications, Morbidity, and/or Mortality

g. An Encounter Dominated by Counseling or Coordination of Care, particularly the
   element of time.

h. The correct number of elements of CC, HPI, ROS, PFSH, and Examinations to
   correspond with the Complexity of Medical Decision Making and CPT chosen.


International Classification of Diseases (ICD)

1.   The Bastyr Center uses ICD codes, or diagnosis codes, according to the standards
     agreed upon by the World Health Organization and relies upon reference texts to
     describe these standards. Currently we are using ICD - 9 codes. In 1999 the ICD –
     10 was approved by WHO and we will be updating our references.

2.   During each patient visit the supervising clinician is responsible for choosing the
     correct ICD code for the visit, and for recording it in the medical record and on the
     patient billing form. Instructions for choosing ICD codes are found in the front of
     reference texts.

3.   Important principles for choosing ICD codes include:

           a. The most specific code available for the patient's condition must be
              identified.

           b. The first diagnostic code referenced on the billing form must describe the
              primary of most important reason for the care provided. This is called the
              Primary Diagnosis.

           c. The ICD code chosen must be consistent with and substantiated by
              information recorded in the subjective, objective, assessment and plan
              sections of the patients written record.

           d. Every condition, and only the conditions, actively addressed during the
              patients present clinic visit must be assigned a specific ICD code. All
              ICD codes pertaining to an individual patient visit must be recorded in the


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               required locations in the written record, including the assessment section,
               and on the billing form.

           e. All ICD – 9 codes must be numbered by priority on each billing form and
              in the patient chart.

           f. Please refer to Documentation Guidelines for Evaluation and Management
              Services, Appendix 7, for more detailed information.

4.   Patient Care CPT Coding Worksheet

On the following four pages you will find the BCNH Patient Care CPT Coding
Worksheet. It is to be used optionally by supervisors or student clinicians on shift as a
guide to choosing the correct CPT code for the level of visit complexity, the number of
history elements obtained, and the number of physical exam elements performed. All
criteria included in the tables are derived from the Documentation Guidelines.




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Patient Care CPT Coding Worksheet
[Not to be filed with the Medical Record]

New Patients: Requires all three Key Components – History, Physical Exam and
Decision Complexity.
Code              History            Physical Exam     Decision           Counseling
                                                       Complexity         [Health]
99201 Focused     CC:                1 System/Area     Straight Forward 10 minutes
                  HPI [1-3] areas    [1-5 elements]
99202 Expanded CC:                   1+ Systems        Straight Forward 20 minutes
Problem Focused HPI [1-2]            [6 elements]
                  ROS [1] areas
99203 Detailed    CC:                6 Systems/Areas Low                  30 minutes
                  HPI [4-7]          w/2 Elements or
                  ROS [2-9]          2 Systems/Areas
                  PFSH [1] areas     w/12 Elements
99204             CC:                9 Systems/Areas Moderate             45 minutes
Comprehensive     HPI [4-7]          w/2+ Elements
                  ROS [10]
                  PFSH [3]
99205             CC:                9 Systems/Areas High                 60 minutes
Comprehensive     HPI [4-7]          w/2+ Elements
                  ROS [10]

Return Patients: Requires 2 of the following 3 Key Components – History, Physical
Exam, and Decision Complexity

Code               History             Physical Exam     Decision           Counseling
                                                         Complexity         [Health]
99212 Focused      CC: HPI             1 System/Area     Straight Forward   10 minutes
                                       [1-5 elements]
99213 Expanded     CC:                 1+ Systems        Low                15 minutes
Problem Focused    HPI                 [6 elements]
                   ROS [1]
99214 Detailed     CC:                 6 Systems/Areas   Moderate           25 minutes
                   HPI                 w/2 Elements or
                   ROS [2-9]           2 Systems/Areas
                   PFSH [1]            w/12 Elements
99215              CC:                 9 Systems/Areas   High               40 minutes
Comprehensive      HPI                 w/2+ Elements
                   ROS [10]
                   PFSH [3]




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History of Present Illness [HPI] Includes the   HPI Notes
Elements Listed Below
Location                                        Brief HPI: The medical record should
Quality                                         describe 1-3 elements of the present illness.
Severity
Duration                                        Extended HPI: Description should include at
Timing                                          least 4 elements of the HPI or the status of at
Context                                         least 3 chronic or inactive conditions.
Modifying Factors
Associated Signs and Symptoms

Past Family and/or Social History (PFSH)        PFSH Notes
Consists of a Review of 3 Areas
Past History: The patients past experiences     Pertinent PFSH: At least one specific item
with illnesses, operation, injuries, and        from any of the three history areas must be
treatments                                      documented of a pertinent PFSH.

Family History: A review of medical events       Complete PFSH: At least one specific item
in the patients family, including diseases which from each of the three history areas must be
may be hereditary of place the patient at risk   documented.

Social History: An age appropriate review of
past and current activities

Review of Systems [ROS]                         ROS Notes
For purposes of ROS, the systems listed below
are recognized:
Constitutional Symptoms [e.g. fever, weight     Problem Pertinent ROS: The patient's
loss, etc.]                                     positive responses and pertinent negatives for
Eyes                                            the system related to the problem should be
Ears, Nose, Mouth, Throat                       documented.
Cardiovascular
Respiratory                                     Extended ROS: The patients positive
Gastrointestinal                                responses and pertinent negatives for 2 – 9
Genitourinary                                   systems should be documented
Musculoskeletal
Integumentary                                   Complete ROS: At least 10 organ systems
Neurological                                    must be reviewed. Those systems with
Psychiatric                                     positive of pertinent negative responses must
Endocrine                                       be individually documented. For the
Hematological/Lymphatic                         remaining systems, a notation indicating all
Allergic/Immunologic                            other systems are negative is permissible. In
                                                the absence of such a notation, at least 10
                                                systems must be individually documented.



                                       Page 137
Physical Exam Elements Required Should be Circled Below by Doctor
Vitals                                    Cardiovascular
Height________________________________ Palpation/Auscultate
Weight________________________________ Heart_________________________________
RR___________________________________ Edema________________________________
HR___________________________________ Carotids_______________________________
BP___________________________________ Abdominal Aorta_______________________
Temp_________________________________ Femoral Arteries________________________
General Appearance_____________________ Pedal Pulses____________________________

Eyes                                       Chest/Breast
Conjunctive/Lids_______________________    Inspection_____________________________
Pupils/Iris_____________________________   Palpation of Breasts/Axillae_______________
EOM________________________________
Fundus_______________________________

Ears/Nose/Mouth/Throat                     Gastrointestinal
External                                   Examination of Abdomen_________________
Ears/Hearing___________________________    Liver/Spleen____________________________
Otoscopic Exam________________________     Check for Hernial_______________________
External Nose/Nasal Mucosa______________   Anus/Rectum__________________________
Lips/Teeth/Gums_______________________     Guaiac________________________________
Oral Mucosa/Pharynx____________________

Neck                                      Genitourinary [Male]
Examine Neck__________________________ Penis_________________________________
Palpation of Thyroid_____________________ Scrotum_______________________________
                                          Prostrate______________________________

Respiratory                                Genitourinary [Female] Pelvic Exam
Effort_________________________________    External Genitalia_______________________
Percussion of                              Urethra_______________________________
Chest______________________                Bladder_______________________________
                                           Cervix________________________________
                                           Uterus________________________________
                                           Ovaries_______________________________
                                           Vaginal Mucosa________________________

Lymphatic Palpation in 2+ Areas            Skin
Neck_________________________________      Inspect_______________________________
Axillae________________________________    Palpate_______________________________
Groin_________________________________
Other______________________________
Musculoskeletal
Gait__________________________________     Examine joints/bones/muscles of 1+ of the
Digits/Nails____________________________   following 6 areas:

                                  Page 138
                                         Head/Neck____________________________
Inspect or palpate for misalignment,     Spine/Ribs/Pelvis_______________________
asymmetry, crepitation, etc:             Right Upper Extremity___________________
ROM_________________________________ Left Upper Extremity____________________
Stability_______________________________ Right Lower Extremity___________________
Muscle Strength/Tone____________________ Left Lower Extremity____________________

Neurologic                                Psychiatric
Cranial Nerves_________________________   Describe patients judgment and
Sensation_____________________________    insight________________________________
DTR’s_______________________________      _____________________________________
                                          Mental Status Including:
                                          Orientation in
                                          Time/Place/Person_______________________
                                          Memory:
                                          Recent________________________________
                                          Remote_______________________________
                                          Mood/Affect___________________________

Other Comments/Additional Instructions:   Notes for Coding

                                          Problem Focused: A limited examination of
                                          the affected body area or segment or organ
                                          system. 1-5 elements.
                                          Expanded Problem Focused: A limited
                                          examination of the affected body area or organ
                                          system and any other symptomatic or related
                                          body area or organ. 6+ elements.
                                          Detailed: An extended examination of the
                                          affected body area of organ system and any
                                          other symptomatic or related body area or
                                          organ system. At least 2 elements from each of
                                          the 6 areas or at least 12 elements in 2+ areas.
                                          Comprehensive: A general multi-system
                                          examination of a single organ system and other
                                          symptomatic or related body area or organ
                                          system. All elements in at least 9 areas.




                                  Page 139
PATIENT SCHEDULING

Student clinicians are encouraged to contact and bring in your own patients through
outreach/community education, public talks, participating in wellness clinics and health
fairs, and talking to your friends. You can also go back through past clinic patient files
and call patients. Please see the Medical Director first.

1.   During spring quarter, Fourth year (or 5th year) ND, and third year AOM graduating
     student clinicians, need to begin the process of providing a smooth transition of
     transferring the primary responsibility of care for your patients to the third year
     student clinicians under the same supervising faculty. You are required to notify
     your patients, your supervising physicians, and the student clinicians you are
     referring the patient to about this transition, and to note this transfer in the patient
     chart. This transition will take place by graduation, so that all patients will continue
     with the same supervising physician/Clinical Faculty and new fourth year student as
     the primary student clinician. Once you graduate, you will not be able to see
     patients until you are licensed as a physician (ND) or as an acupuncturist with
     NCCA certification (AOM). You must graduate and pass the board exams, and
     obtain your license in order to see patients.

2.   The front desk has a system of scheduling FOC’s that is fair for everyone. Student
     clinicians may not make any requests to restrict FOC’s in their rooms.

3.   If arranging an appointment for a patient, students need to have the patient call in to
     schedule an appointment. Students must never schedule appointments, or ever write
     or erase in the appointment book. It is fine to tentatively arrange with a patient
     when to come in, but the patient must be the one to actually contact the front desk to
     schedule the appointment.

4.   You must have your patients scheduled on regular clinic shift time.

AOM/ND/NUTRITION: PATIENTS REFERRED TO CLINIC

1.   ND: Patients directly referred by another physician or supervising Clinical Faculty
     for lab tests, physical medicine treatment or dispensary items may be seen and/or
     treated without the usual FOC work-up. A chart should be made up with a
     note/short summary of the complaint/care from the referring physician and what
     type of treatment she/he wants for her/his patient in physical medicine. If a patient
     does not bring the appropriate written and signed information from the referring
     physician, please telephone the referring physician for authorization.

2.   ND and AOM and Nutrition: A thank you letter should be composed, typed and sent
     to any referring physician in appreciation for sending her/his patient to us.




                                         Page 140
3.       ND and AOM and Nutrition: A letter summarizing the patient’s visit and/or treatments
should be sent to a referring physician after an appropriate number of visits, typically three
visits, or after pertinent diagnostic or therapeutic outcomes are achieved.




                                               Page 141
AOM /ND/ NUTRITION PATIENT REFERRALS TO OUTSIDE
PHYSICIANS/HEALTH CARE PROVIDERS

1.   A brief referral letter should be typewritten by the primary or secondary student
     clinician to either send with the patient to the acupuncturist/health care practitioner,
     or to be mailed. This letter should include the patient’s identifying information, the
     presenting complaints and other relevant subjective information, any objective
     findings, the assessment or rule outs (differential diagnosis), the reason for the
     referral and what tests or diagnostic procedures to perform. State whether or not the
     acupuncturist/health care practitioner should institute treatment as she/he sees
     appropriate, or whether she/he should consult back with the supervisor first. This
     letter needs to be signed by the acupuncturist/health care practitioner, photocopied
     and the original sent with the patient and the copy placed in the chart.
      Templates and sample letters appear in Appendix #8 and are available from your
     supervisor.



INTRACLINIC REFERRALS

Student clinicians are encouraged to consider referrals, to other departments within the
clinic. There is an intraclinic referral letter (see Appendix #8) which should be filled out
and signed by the supervisor for all intraclinic referrals. Referred-to clinicians/supervisor
teams are encouraged to write treatment summary notes at the conclusion of entries back
to the referring supervisor and clinicians.




                                         Page 142
LAB
BASTYR CENTER FOR NATURAL HEALTH
Clinical Laboratory

Laboratory workflow and hours of operation



Laboratory hours of operation are as follows:
       Open           8:30 a.m. to 8:30 p.m. Monday, Tuesday, Thursday
                      8:30 a.m. to 5:00 p.m. Wednesday and Friday

        Closed         12:30 until 1:30 on all days
                        4:30 until 5:30 on Monday, Tuesday, Thursday

If the lab staff must be out of the lab for any reason and will be gone longer than 10
minutes, there will be written instructions in the lab indicating where to find the tech and
when to expect them to return.

All laboratory testing is done on a first-come basis during the shift.
All specimens are to be placed on the island bench. LABEL: patient last name, first
name; date collected; source.
Place completed lab requisition in wall rack.

If you need a result before your patient leaves, please mark this request and the time by
which you need it on the lab requisition and verbally notify the laboratory personnel.

If you need the result immediately, please indicate STAT on the requisition and verbally
notify the laboratory personnel. This request should only be used in the event of an
emergency, since most of the work is done ASAP.

Any specimen brought to the lab later than 10 minutes before closing will be accepted
and billed. However, the test may not be run and result will not be released until the next
shift.


        Processing and or testing of a sample can take up to 30 minutes to perform
depending on what is requested. It is during the immediate post-closing time that work
already requested is finished, and the laboratory is cleaned and disinfected for the next
day. The lab asks that all lab work be brought to the lab or be requested 30 minutes
prior to the lab’s posted closing time. Should there be an emergency that may
require the lab to remain open past its closing time, please notify the lab personnel
as soon as possible.



                                         Page 143
For patients who need Laboratory work during closure hours, please re-appoint
them to another shift or day.

Lab Test fees and Laboratory Billing

       Only laboratory personnel will quote test fees. When discussing options with
patients, the telephone in the exam room may be used to get this information. If there is
no telephone, or the laboratory personnel are unable to pick up a call, the secondary
clinician must come to the laboratory.

       Reference laboratories may have a multi-tiered fee schedule. When this is the
case, a discussion with laboratory personnel is required to clarify which schedule to
apply. Criteria to determine such application include:

Insurance coverage
Payment at time of service option
Payment included with specimen option
Specific reference laboratory offering the requested test(s)

This is the new procedure:

        Laboratory personnel do patient billing for laboratory testing. Based on the above
criteria, a bill will be generated which will be taken to the front desk as it is completed.
The provider is responsible for indicating that laboratory testing was requested for the
patient during the visit, by circling the “LAB” heading on the visit superbill.
     Any tests that are subsequently requested will be billed to the patient by the testing
entity.

Thanks for your help in making this a habit. It will insure that all bills are to the front
desk in a timely manner, and will key the front desk personnel to look for the bill.

Requesting Laboratory tests

Laboratory tests are to be ordered using appropriate BCNH and external reference lab
requisition forms, correctly filled out and signed by a supervising physician. When tests
are ordered in advance of sample collection the requisition(s) are filed in the Lab.
Patients must schedule with the Appointments Desk for a lab appointment and sample
collection unless a lab test is needed on-shift, STAT. Any ND supervisor may order lab
tests STAT and when doing so should make the nature of the order very clear to the lab
technician.

Samples collected from patients in exam/treatment areas must be handled and transported
to the Lab in accordance with OSHA guidelines, including containing samples
completely and transporting in a gloved hand(s).



                                          Page 144
Original reports of lab test results will be placed in the ordering physician’s mailbox for
review, response and signature, whereupon the physician will route the reports to the
patient’s chart for filing by placing the signed report in the faculty box hanging on the
outside of the chartroom door. Duplicate copies of all lab reports are stored for two
months in the Lab.

Laboratory Results To Be Charted: File Location


        It is the responsibility of the Clinic Medical Records office to chart the official,
final copy of all lab results. If it is necessary to find a result that is not yet charted, the
laboratory maintains copies of all patient results.

The copy is not the official document and must be returned to the laboratory.

        A file for various medical records is located in the 2nd floor hall across from the
copier. The doctor is responsible for bringing results that are ready to be charted to this
file. Medical Records personnel check the file several times during the week and will
place the results into the appropriate chart(s). If a chart cannot be found, the result(s)
will be held in Medical Records office. Please direct all requests to that office.

Laboratory tests requested by non-ND providers


        This policy is to be followed in the event of an acute need for patients being seen
in clinics where a Naturopathic physician is not the primary care provider.

         The provider currently seeing the patient comes to ND patient care areas and
locates an ND with whom to consult, at no charge to the patient. The ND has the option
of seeing the patient and to order the test(s) or not, after their assessment of the situation.
The ND may also decide that it is most appropriate to schedule an ND office call for a
more complete evaluation.
         If the ND agrees to order the test(s) that day, they are responsible for personally
filling in and signing a laboratory requisition form, to ensure all information is entered
correctly. It is the responsibility of the patient’s original clinical team to advise the
patient that a brief ROC may be scheduled with the ordering ND to discuss the test
results, per the ND’s instructions during the consultation. Please note that the consulting
ND is responsible for all follow-up and intervention regarding the lab test result(s) with
the patient. This can be accomplished at a scheduled appointment or by telephone, as
appropriate.

        The laboratory requisition form is given to the patient’s student clinicians, who
are responsible for bringing it to the laboratory.
        Laboratory staff is responsible for submitting the laboratory bill to the front desk,
with the appropriate charges marked. The results are to be given to the ordering
physician.

                                           Page 145
Gynecological Cytology Services

Papanicolaou (PAP) staining of endocervical, ectocervical, and vaginal smears is an
important aspect of women’s health care. A separate Cytology notebook details the
services offered. This notebook is available from the Client Services staff and includes
sections on:

               General Information
               Specimen Collection
               Patient Statistical and Follow-up Reports
               Terminology/Classification Standards
               Special Services

Collection supplies including slides, cytobrush, modified Ayre spatula, and Pap Paks are
available at no charge from the Laboratory.

Collection Techniques:

Almost all cancers of the cervix begin near the squamocolumnar junction. It is
imperative, therefore, that smears be taken from this area. For optimal evaluation, the
Laboratory favors the technique as outlined below.
Prior to obtaining the cervical sample:
a) Write the patient’s name in pencil on the frosted end of the glass slide.
b) Have Pap Pak opened.
c) Indicate on the request form all pertinent information about the patient such as last
menstrual period, radiation therapy, IUD, clinical cancer, hormone therapy, previously
abnormal cytology.

Excess mucus should be removed from the uterine cervix and vagina before the samples
are taken.

Ectocervical Sample – Using a modified wooden Ayre spatula, obtain a sample from the
ECTOCERVIX. Rotate and scrape the external OS. The sample material should be
gathered into a small area at one end of the slide. Then collect the endocervical specimen
promptly, and do not allow the ectocervical specimen to air dry.

Endocervical Sample – Using a cytobrush, obtain a second sample from the
ENDOCERVIX. Rotate within the endocervical canal. Please note that a cytobrush
should not be used on pregnant patients.




                                        Page 146
Smear Preparation – Mix the ectocervical and endocervical samples together with the
brush, and then roll the brush across the entire slide (excluding the frosted label area)
creating an even and thin smear. Fix immediately in the fixative from the Pap Pak.

If hormonal evaluation is needed, an additional smear may be obtained by scraping the
lateral VAGINAL wall. This sample should be thinly spread on a separate slide and
fixed IMMEDIATELY in the fixative from the Pap Pak. Label slide M.I.

Notes and Precautions:

The ectocervical sample initially gathered in a small area at one end of the slide should
not be allowed to air dry. The endocervical sample should be collected promptly and
mixed with the ectocervical sample. The combined sample material is then spread thinly
and evenly over the entire slide (excluding the frosted label area) to prepare the smear.

Lubricant should not be used as it obscures cellular detail.

The use of a cytobrush can significantly improve the collection of endocervical cells at
the squamocolumnar junction. The following cautions govern their use, however:
You may want to inform your patients that, due to the thorough sampling of the
endocervical canal by the cytobrush, there may be some minor painless spotting for a day
or two following the PAP test.
NEVER reuse the cytobrush.
Insufficient clinical data exists regarding its use on pregnant patients. DO NOT USE on
pregnant patients.
The cytobrush MUST NOT be used for sampling from the endometrium.

Test                                                  Code                  CPT
GYN Cytology (PAP)                                     985                  88156
GYN Cytology (PAP, Pathologist review)                1987                  88157

Medicare Requirements for PAP Smear Billing:

An appropriate ICD-9-CM diagnosis code must be submitted on all Medicare patients.
Contact Cytology Client Services at (206) 386-2822 or (800) 458-6836 for a list of
appropriate codes.




                                         Page 147
Naturopathic Treatment of Malignancy

Chapter 18.57 or 18.71 RCW of the naturopathic licensing law states:
“The practice of naturopathy includes manual manipulation (mechanotherapy), the
prescription, administration, dispensing, and use, except for the treatment of
malignancies or neoplastic disease, of nutrition and food science, physical modalities,
homeopathy, certain medicines of mineral, animal, and botanical origin, hygiene and
immunization, common diagnostic procedures, and suggestion; however, nothing in this
chapter shall prohibit consultation and treatment of a patient in concert with a practitioner
licensed under chapter 18.57 or 18.71 RCW.”

1.        Upon review by Bastyr University law firm, the statutory limitation in this aspect of
          our law is that a N.D. may not "treat malignancies” except “in concert with” an
          M.D. or D.O. Therefore, if an N.D. is providing care to a cancer patient for any
          purpose other than treatment of his or her malignancy, there is no unusual limitation
          to the N.D.’s scope of practice.

2.        However, when a N.D. is providing curative treatment for the malignancy, the N.D.
          is within his or her scope only if the curative treatments are “in concert with” an
          M.D. or D.O. There is no formal guidance on what it means to be acting “in concert
          with” an M.D. or D.O. from either the courts or the Department of Health. Mr.
          Burgon has advised us in this regard as follows.

                a. At a minimum, the N.D. must be confident that she or he is fully aware of
                   the M.D.’s prescribed course of treatment. This is likely to require
                   interaction with the M.D. or D.O. in order to obtain the necessary medical
                   records or other direct knowledge of the patient’s treatment.

                b. It is important to note, however, that the N.D. does not have to be
                   subservient to the M.D.’s direction. The N.D. must only provide
                   treatment that is in harmony with the medical regimen and must inform
                   the M.D. of the treatment being provided.

     3.     In light of this interpretation, we have revised the informed consent form for the
            treatment of malignancies (see attached). It is your responsibility to ensure that
            any patient for whom you are treating malignancy, the symptoms thereof, or the
            side effects of their conventional treatment for their malignancy, sign this consent
            form prior to your treatment.

     4.     And, to summarize your role:
            In order to treat patients with malignancy we must:

                a. be fully aware of the patient’s M.D. or D.O.’s prescribed course of
                   treatment, as documented in the patient’s medical records or as
                   documented from a charted conversation that you have had with the
                   patient’s M.D. or D.O

                                             Page 148
       b. provide treatment that is in harmony with the patient’s conventional
          treatment (to the best of the medical profession’s current state of
          knowledge)

       c. regularly inform the patient’s M.D. or D.O. of the treatment that you are
          providing to the patient.

5. As long as a patient is under the care of an M.D. or D.O. for their malignancy, we
   may treat this patient’s malignancy. If a patient has refused the treatment
   recommended by their M.D. or D.O., we must document their voluntary informed
   refusal of that treatment. We must continue to adhere to the above stated
   communication guidelines in your care of this patient.




                                   Page 149
INTERPRETER SERVICES POLICY

After a thorough legal review, the following policy regarding interpreter services
provided by Bastyr Center for Natural Health has been formulated.

   1. Under Title VI of the Civil Rights Act of 1964, the Office for Civil Rights has
      determined that language assistance is appropriate when language barriers cause
      persons with limited English proficiency (LEP) to be excluded from or denied
      access to clinical services. The key to ensuring equal access for the LEP client is
      to ensure that the service provider and the LEP client can communicate
      effectively, i.e. the LEP client should be given information about, and be able to
      understand, the services that can be provided by the provider and must be able to
      communicate his/her situation to the provider.

   2. In order to meet these guidelines for services provided to LEP patients by Bastyr
      Center for Natural Health providers, there are several interpreter options:

           a. A health care provider is required to obtain “informed consent” prior to
              commencing treatment. The Center’s Informed Consent form is written in
              English. It is imperative that an interpreter translate this form in its
              entirety to the LEP patient so that the patient is able to give informed
              consent to treatment (or non-treatment). This consent is indicated by the
              patient’s signature on the Informed Consent form.
           b. While the provider cannot require a patient to use family members or
              friends as interpreters, a family member or friend may be used as an
              interpreter. It is important that the use of a family member or friend not
              compromise the patient’s confidentiality or the effectiveness of services.
              According to Washington state law on patient confidentiality, a patient’s
              confidentiality may be compromised by the use of a family member or a
              friend as an interpreter if highly sensitive areas, such as HIV/AIDS,
              sexually transmitted diseases, drug and alcohol treatment and mental
              health issues, are discussed. Given these guidelines, the supervising
              faculty provider must assess whether the confidentiality or effectiveness of
              services is compromised by a patient using a family member or friend as
              an interpreter. If confidentiality or effectiveness of services is deemed to
              be compromised, other interpreter options must be pursued.




                                        Page 150
          c. A student who is proficient in the patient’s language and in the English
             language and who is familiar with medical terminology is considered a
             competent interpreter. Thus, student clinicians may act as interpreters for
             LEP patients with the permission of the patient and the approval of the
             supervising faculty member.
          d. The AT&T Language Line may be used to provide interpretation and
             translation for patients. This service will need to be pre-arranged by the
             front desk staff in coordination with the patient. Any costs incurred in the
             interpretation are the responsibility of the patient.
          e. LEP patients may use certified interpreters. The patient is responsible for
             making arrangements for these interpreters and for paying these
             interpreters. The front desk will provide contact information for interpreter
             services to interested patients.


3.   Under the American Disabilities Act, all clinical service providers are required to
     provide sign language interpreters for all deaf persons. The cost of these
     interpreters is the responsibility of the clinic, and in some cases, may be shared
     with the patient’s health insurer.




                                       Page 151
AOM/ND/ NUTRITION TELEPHONE CONTACT
1. Please observe the following rules for phone contact:
          a. The clinic phones are for clinic business only.
          b. All calls to patients must be pre-approved by the supervising
              physician/Clinical Faculty.
          c. If the patient’s residence is long distance, you must obtain permission to
              call from a supervisor and use a Clinical Faculty phone.
          d. Calls to/from patients should be limited to 3 minutes. These calls should
              be limited to determining the status of the patient, reporting test results,
              clarifying treatment instructions, or recommending follow up. If the call
              is longer than this, consider scheduling the patient for an office call, or
              consultation. A phone contact should not replace an office visit.
          e. You are legally responsible for phone advice. A note in the chart must be
              made with the date, reason for the call and any pertinent information or
              advice. You and the supervising physician/Clinical Faculty should then
              sign this. Do not offer any new treatment advice or change any treatment
              plan without the approval of the supervising Clinical Faculty.
          f. There is a student phone in the lounge that should be used for local,
              personal calls.
          g. Students should never give home phone numbers to patients. Any
              business that you need to discuss with a patient should take place at the
              clinic in person or by phone.
2. Pagers/Cell Phone Usage
      All pagers and cell phones must be on vibratory alert mode while in the clinic.
      Furthermore, it is not permissible to answer these calls in a room with a patient
      during a patient visit.
      Urgent calls may be answered outside of patient care rooms.

3. Clinic Telephone Paging System
       While paging may be disruptive to a patient visit, it is critical that student
       clinicians and supervisors be able to hear pages at all times. All telephone pages
       require immediate attention; some pages are of an emergency or urgent nature.
       From this point forward, it will be the responsibility of the observing or secondary
       student in each room to make sure that the volume of the telephones is at an
       audible level. Failure to comply may result in a failure event for that student.
       Please know that we are in a process of developing a triage system for paging
       calls. This process should result in fewer and only essential pages. If you have
       any questions about this policy or telephone operation, please contact your shift
       supervisor.

HANDWASHING AND DISINFECTION
    All students are required to wash hands with soap and warm water before and
    after every patient visit. Disinfection of surfaces (exam tables, sink and
    countertop, lamp, etc.) must be performed between each patient visit. Refer to
    infection control manual located in lab for details.

                                        Page 152
ND AND AOM CLEAN NEEDLE TECHNIQUE AND BIOHAZARD WASTE
HANDLING

You are responsible for knowing the OSHA guidelines for blood borne pathogens. You
are required to view a training video and sign a document acknowledging that you
understand these guidelines annually. Please follow the clinic policies for handling
biohazard materials by placing disposables in the biohazard bags located in each exam
room. Reusable instruments should be taken immediately to the supply room for
cleaning and sterilization. Biohazard materials include all supplies and instruments that
have come into contact with patient body fluids, such as blood, urine, vaginal secretions,
saliva, etc. See the Safety Manual in the laboratory or ask the current infection control
representative for details.

Acupuncture Needle Policy

1.    An acupuncture needle count will be made prior to any treatment and initialed by
      the intern before insertion. Any needles added or removed during the treatment
      must be recorded. After removal of all needles a final count must be made and
      initialed by the intern(s) and by the supervisor. This information must be recorded
      on the chart notes for every visit.

2.    Any lost needle must be brought to the attention of the supervisor. A continued
      lost needle will result in a flagged garbage to be deposited in the blood borne
      pathogens “box” and laundry from the room will be flagged. A special notice will
      be placed on the door alerting the janitorial crew to the lost needle in the room. On
      rare occurrences it is possible a patient will take a needle home that dropped into a
      pants cuff or elsewhere in clothing. A decision may be made to call a patient and
      alert them to this possibility.

3.    “Lost needle” incidents will be recorded by the supervisor and brought to the
      attention of the Clinic Program Coordinator immediately. The Clinic Program
      Coordinator will record the incident and send a copy to the Clinic registration staff
      to be placed in the student’s record. Any pattern of continual occurrences of lost
      needles will result in clinical sanctions. If the needle is found related to a specific
      room or shift this could result in clinical sanctions for the clinicians in that room.

4.    All private practice acupuncturists working out of the NHC will be alerted to this
      policy and the clinic’s concern. If needles are found related to private practice the
      Clinic Medical Director must be notified so proper feedback may be initiated.
      Needles from private practice will be taken as seriously as those found in the
      teaching clinic.




                                         Page 153
SENTINEL EVENTS
PROCEDURE: REPORTING AN OCCUPATIONAL ACCIDENT/ILLNESS
EVENT

It is understood that this procedure is for any occupational injury or illness occurring on
the Clinic premises or caused by the working environment.
1. In case of illness
            a. Notify supervisor
            b. Supervisor shall complete the ‘Occupational Illness/Injury Report Form’
                 with employee
            c. Employee shall be seen by a provider of their choice (i.e.: at the Clinic or
                 elsewhere)
            d. Supervisor shall immediately forward paperwork to the Clinic Safety
                 Coordinator
            e. Safety Coordinator will forward paperwork to Human Resources
                 Department within 24 hours of the incident and continue the evaluation
                 process (see sec. V. B.)
2. In case of accident
            a. Notify employee/student’s supervisor
            b. Supervisor shall immediately contact nearest available ND provider and
                 then contact the front desk
            c. Provider is responsible for physical assessment of any injury and shall
                 approve moving the injured person only if safe to do so. Please refer to
                 Emergency Manual located in the laboratory.
3. Front desk is responsible for the following:
        a. Furnish ‘Occupational Illness/Injury Report Form’ to provider/supervisor
        b. Arrange for an exam room
        c. Contact appropriate emergency responders per provider’s instructions
4. Supervisor and provider will begin appropriate paperwork with employee as soon as
possible, following the injury
5. Supervisor will forward paperwork to the Clinic Safety Coordinator within 24 hours of
the incident
6. Safety Coordinator will continue evaluation process (see sec. V. B).
7. Emergency transport of patient will be 911 vehicle
8. In case of a Sentinel Event. Sentinel Event is defined as an unexpected occurrence
involving death or physical or psychological injury, or the risk thereof. Such events are
called “sentinel” because they signal the need for immediate investigation and response.
  A. Front desk is notified and is responsible for the following:
    1. Page senior ND provider to the site using the in-house emergency contact schedule
    2. Arrange for exam room
    3. Furnish ‘Occupational Illness/Injury Report Form’ to provider/supervisor
     4.Contact appropriate emergency responder per instructions from provider




                                        Page 154
B. The following administrators must be notified immediately
1. Dean of Clinical Affairs
2. Clinic Medical Director
3. Clinic Administrator
4. Clinic Safety Coordinator

C. Paperwork requirements
1. Supervisor or provider must complete the ‘Occupational Injury/Illness Incident
     Report Form’, to include
2. Date, time and place of incident
3. Complete detailed description of incident, including any object(s) or machinery
     involved
4. Nature of incident
5. Indicate basic cause and any contributing cause(s)
6. Safety Coordinator completes investigation of events
7. Conducts interviews with all persons directly involved
8. Presents evaluation to Clinic Safety Committee which is responsible for the
     following:
9. Review evaluation
10. Develop action plans and establish time lines for completion, including but not
     limited to
11. Documentation of response to the incident
12. Identification of deficiencies
13. Suggestions for improvement(s) to the response
14. Write recommendation(s) and send to
15. Supervisor/provider who was directly involved
16. Clinic Program Coordinator
17. Clinic Medical Director
18. Clinic Manager
19. Dean of Clinical Services
20. OSHA 200 Log and Summary Form is required to be completed for each event, and
     is the responsibility of the Safety Coordinator.
21. Copies of all paperwork will be forwarded to Bastyr University Health and Safety
     Office on the main campus




                                     Page 155
PROCEDURE: REPORTING A VISITOR/PATIENT ACCIDENT/ILLNESS
EVENT
It is understood that this protocol is to be for any injury or illness occurring on the
Clinic premises or as a result of a product purchased from the Naturopathic
Dispensary or the Oriental Medicine Dispensary

1. In case of illness/accident on the premises of the Clinic
            a. Front desk is notified and is responsible for the following:
            b. Page senior ND provider to the site using the in-house emergency contact
                 schedule
            c. Arrange for exam room
            d. Furnish ‘Patient/Visitor Incident Report Form’ to the provider of record
            e. Provider of record completes top portion of form and forwards paperwork
                 to the Clinic Safety
            f. Coordinator within 24 hours of the incident

2. Safety Coordinator/Risk Management Officer is responsible for contacting the
University’s liability company

3. Safety Coordinator shall copy all paperwork to the Clinic Medical Director and
Manager within 24 hours

4. Emergency transport of patient will be 911 vehicle

5. In case of injury from or adverse reaction to any product purchased from the Clinic
            a. Dispensary staff notifies supervisor to discuss event with patient
            b. Supervisor determines extent of problem; refer to Emergency Manual
                located in clinic laboratory.
            c. Refers patient to provider if necessary to discuss specific nature of
                problem
            d. Dispensary staff and/or supervisor completes top portion of
                ‘Patient/Visitor Incident Report Form’, and
            e. forwards paperwork to Clinic Safety Coordinator within 24 hours of the
                incident




                                       Page 156
In case of a Sentinel Event
Sentinel event is defined as an unexpected occurrence involving death or physical or
psychological injury, or the risk thereof. Such events are called “sentinel” because they
signal the need for immediate investigation and response.

1. Front desk is notified and is responsible for the following:
            a. Page senior ND provider to the site using the in-house emergency contact
                schedule
            b. Arrange for exam room
            c. Furnish ‘Patient/Visitor Incident Report Form’ to provider of record
            d. Call appropriate emergency responder per provider instructions
            e. The following administrators must be notified immediately
            f. Dean of Clinical Affairs
            g. Clinic Medical Director
            h. Clinic Administrator
            i. Clinic Safety Coordinator
2. Paperwork requirements
            a. Supervisor or provider must complete the top portion of the ‘Injury/Illness
                Incident Report Form’, to include
            b. Date, time and place of incident
            c. Complete detailed description of incident, including any object(s) or
                machinery involved
            d. Nature of incident
            e. Indicate basic cause and any contributing cause(s)
3. Safety Coordinator completes investigation of events
            a. Conducts interviews with all persons directly involved
            b. Presents evaluation to Clinic Safety Committee which is responsible for
                the following:
            c. Review evaluation
            d. Develop action plans and establish time lines for completion, including
                but not limited to
            e. Documentation of response to the incident
            f. Identification of deficiencies
            g. Suggestions for improvement(s) to the response
            h. Write recommendation(s) and send to
4. Supervisor/provider who was directly involved
            1. Clinic Program Coordinator
            2. Clinic Medical Director
            3. Clinic Administrator
            4. Dean of Clinical Services
5. Follow-up by Safety Coordinator, as recommended by the Committee
6. Clinic Medical Director shall contact patient as deemed necessary to ensure patient
satisfaction
7. Copies of all paperwork will be forwarded to Bastyr University Health and Safety
Office on main campus


                                        Page 157
COMMUNICABLE DISEASE OUTBREAK


Communicable Disease Outbreak
Guidelines for dispensing information to Bastyr University and center for Natural Health
employees and students in event of communicable disease outbreak.

1. Initial Contact
            a. Testing facility notifies Clinic Laboratory of positive result
            b. Bastyr Clinical Laboratory notifies
            c. Provider of Record
            d. Clinic Safety Officer

2. Safety Officer notifies Clinic Medical Director

3. Medical Director notifies:
           a. Clinic and Campus personnel via email/Vmail
           b. Clinic Students via written notices on bulletin board in student lounge and via
              email.
           c. University Health and Safety Office via email
           1. If unable to contact directly, notify Student Services Office

4. Univ. H/S office of Stu. Svc. Office notifies students via written messages on various
designated bulletin boards, i.e. the white board and others.




                                          Page 158
EARTHQUAKE RESPONSE PLAN
Bastyr Center for Natural Health

  1) When you recognize that an earthquake is occurring, if able drop to the floor and
     take cover under a sturdy desk or table. Hold on to this furniture, as they may be
     moving. If this is not available, seek cover against an interior wall and protect
     your head and neck with your arms. Avoid danger spots such as windows,
     mirrors, hanging objects or tall furniture, which could topple over.

  2) Once the shaking has stopped depart the building immediately, via the safest,
     closest emergency exit. The SAFE ZONES (or meeting area) will be 100 feet
     away from the building, towards the schoolyard.

  3) Floor Safety Wardens, if conditions are not hazardous, will sweep the Center.
     Their students, staff and patients will meet in the safe zone to await instructions
     from the Emergency Policy Director (Dean of Clinical Affairs, Clinic Medical
     Director or Clinic Manager).

  4) The highest-ranking member of the Center will be act as the Emergency Policy
     Director. They will go to the Safety Meeting Zone. The Emergency Operation
     Director, (generally will be the Manger of Operations) will direct the facilities
     personnel (if safe) to inspect the building to look for building integrity and any
     broken lines that would pose a danger.

  5) The facilities staff will return to report to the EOD their findings. The EOD
     discusses this information with the EPD. The EPD will then decide whether to
     call an All Clear or extend the post evacuation period and call necessary
     Emergency Professionals.




                                       Page 159
MISCELLANEOUS

Parking: Students must use on street parking. The Wallingford Plaza (NHC building)
parking lot is reserved for patient parking. Your car will be towed if you violate this rule.
It is suggested that student clinicians attempt to carpool, use Metro, or bicycle if possible.

Copy Machine
The copy machines are for clinic business only. Personal copies, including copying of
class notes need to be made outside of the clinic.
Announcements and Communications
Announcements and other communications are placed in the student mailboxes in the
lounge. General clinic information is posted in the student resource room. Phone
messages are posted on the bulletin board in the hallway outside the Clinic Program
Coordinator’s. Outreach opportunities are posted in the Student Lounge and on outreach
bulletin boards).

STUDENT CLINICIANS MUST CHECK THEIR MAILBOXES AND THE
STUDENT PHONE MESSAGE BOARD EACH TIME THEY ARE IN THE CLINIC.
STUDENT CLINICIANS ARE RESPONSIBLE FOR KNOWING AND
RESPONDING TO ALL INFORMATION IN THEIR MAILBOXES AND ON THE
MESSAGE BOARD, AS APPROPRIATE.




                                         Page 160
BASTYR UNIVERSITY RESIDENCY PROGRAM
INTRODUCTION
The Bastyr Center for Natural Health is a well-established residency program. Currently,
there are naturopathic medicine residency positions for the first-year and second-year.
This is a highly competitive program and attracts graduates from other educational
institutions as well as from Bastyr. The residency program at Bastyr is a closely
supervised program of mentorship. Each resident evolves from an observational role into
an independent role over the course of the year. This progression is monitored and
facilitated by a faculty mentor and by the Residency Program Director. A second year of
naturopathic residency consists of clinical supervision and continued skill development.
All residents have multiple opportunities to do rotations in other local centers both
allopathic and naturopathic.


The Bastyr University Residency Program is designed to provide an opportunity for
naturopathic medical school graduates to strengthen their skills as a naturopathic primary
care provider. The residency program will provide residents the opportunity to enhance
their knowledge and skills in family medicine, application of naturopathic philosophy,
teaching and practice management. The residency program has specific knowledge, skill,
and attitude competencies that are consistent with the progressive level of training
throughout the course of the residency.

The Bastyr Center for Natural Health is the primary teaching facility of the Bastyr
University Residency Program. There are currently 6 first year and 3 second year resident
positions. While the majority of the clinical rotation is within the Center, residents are
given the opportunity to participate in shifts in off-site clinics such as the 45th Homeless
Youth Clinic and the Covenant Shores Geriatric Clinic that are supervised by the
members of the core clinical faculty.

Goals of The Bastyr University Residency Program:
1. To produce in our residents ethical naturopathic physicians who are highly
     competent in the practice of naturopathic family medicine.
2. To develop skilled clinical educators in the natural health sciences that integrate
     mind, body, spirit and nature.
3. To teach our residents core skills essential to leadership roles in a wide range of
     health care systems.
4. To maintain an emotionally supportive environment, encourage intellectual debate,
     and foster life-long professional development.
5. To give our residents the opportunity to provide high quality naturopathic care to
     the people of our community regardless of the socioeconomic status.
6. To assist our residents in actively participating with clinical staff of the Bastyr
     Center of Natural Health that enhances the quality of medical care in our
     community.



                                        Page 161
    CLINICAL COMPETENCIES




  STUDENTS AT BASTYR CENTER FOR NATURAL HEALTH WILL

DEVELOP COMPETENCIES IN THE CLINICAL SKILLS REQUIRED FOR

          PROFICIENCY IN THEIR CHOSEN DEGREE




                        Page 162
Clinic Mission
The mission of Bastyr Center for Natural Health is to create an extraordinary
environment committed to excellence in health care and clinical education that assists
and empowers individuals and the community to achieve better health and a higher
quality of life.

University Global Competencies

Communications skills:
Students in the BCNH will develop writing and speaking skills that will enable them to
communicate in a professional, appropriate and effective manner to colleagues, other
health care providers, patients, and the public. Students will be able to actively listen to
their patients, colleagues, other health care providers and the public and to integrate this
information into their case management. Students will develop their clinical intuition.
Students will develop literacy in medical and professional information.

Critical Thinking:
Students in the BCNH will demonstrate the ability to think critically illustrating their
knowledge, comprehension, application, analysis, synthesis, and evaluation of
information.

Professional Behavioral:
Students in the BCNH will conduct themselves professionally and responsibly with
regards to medical ethics, compassionate behavior, cross-cultural differences, respectful
communication and personal health and wellness.

Clinic Qualities:

Heritage:
Students in the BCNH will develop an understanding and acknowledgement of the rich
heritage inherent in natural medicine and all forms of medicine. Students will appreciate
the philosophy and essence of wholism that natural medicine embodies.

Integration:
Students in the BCNH will develop the skills and professional competence necessary to
demonstrate integration between disciplines, modalities and philosophies.

Career Management:
Students in the BCNH will develop competence relating to professional responsibilities,
career and business management. The students will participate in their professional
community.



                                         Page 163
Principles of Traditional Chinese Medicine
Traditional Chinese medicine (TCM) is a holistic practice based on medical practice
dating from before the Han Dynasty (206 BCE to 220 ACE). TCM therapeutics are
determined by assessments based on pattern differentiation.

Holism is the principle that the whole body-mind spirit is greater than the sum of these
individual parts. TCM practice is directed at the harmonizing of all aspects of the body-
mind-spirit, rather than assessing and treating a single physiologic problem in a
reductionist manner. This style of practice is based on the principle that no part of the
body-mind spirit functions in isolation and that any disharmony will act at many points
distal to the initial disharmony.

Traditional Chinese medical differentiation is based on the determination of a pattern of
disharmony. This pattern of disharmony is based on a detailed assessment of the signs
and symptoms the patient presents at the time of treatment. Such an assessment is tied to
the state of the body-mind-spirit at the time of assessment, and as such is much less
dependent on the determination of an etiology antecedent to the pattern differentiation.
The result of focusing on pattern differentiation is that a group of patients with a single
biomedical disease diagnosis may have different patterns of disharmony, and may require
different treatments, each based on a unique pattern differentiation. An emphasis on
pattern differentiation at the time of treatment will also mean that a patient over a course
of multiple treatments for the same biomedical disease require different treatments based
on changes in pattern differentiation as the disease progresses or is ameliorated by
ongoing treatment. TCM assessment is a dynamic and evolving process that looks at the
total state of the patient as this state evolves.

1.    Traditional Chinese Medicine is based on the theory that patterns of energy (Qi)
      flow through the body, interconnect the individual's internal and external
      environments, and are affected by the larger universe. Individuals and their energy
      are affected by external extremes called the six exogenous pathogenic influences,
      which are wind, cold, damp, dryness, summer heat, and fire as well as the seven
      emotions, which are joy, anger, melancholy, worry, grief, fear and fright.
      Additional factors that contribute to the onset of disease are overworking, improper
      diet, lack of physical exercise, traumatic injury, phlegm fluid accumulation,
      stagnant blood, and insect or animal bites.

2.    Illness and disease are represented as disharmonies between the extremes (yin and
      yang, interior or exterior, cold or hot, excess or deficiency). When yin and yang
      are in proper dynamic relationship, an individual will be able to adapt to the
      environment in a way which is not only free from disease (either active or
      subclinical), but also in a way that promotes growth and an individual perception of
      wellness. In this sense, the root cause for the occurrence and development of
      disease can be understood as the imbalance of yin and yang. An individual will be
      able to withstand the assaults of the six exogenous pathogenic influences, seven

                                        Page 164
     emotions and other factors discussed above as long as yin and yang are in dynamic
     equilibrium.

3.   Thousands of years of clinical experience and scholarly research and discussions
     have lead to a complex and detailed accumulation of medical theories involving the
     human body and its physiological functions. The broad categories of these theories
     are the organ systems (zang fu); vital substances (qi, blood, and body fluids, jing);
     and meridians and collaterals. The meridians and collaterals are pathways in which
     the qi and blood of the human body are circulated. There are twelve regular
     meridians, eight extra meridians, twelve divergent channels, twelve tendomuscular
     regions, twelve coetaneous regions, as well as fifteen collaterals. They form the
     network that connects interior organs, tissues, and physiological processes into an
     organic whole. Acupuncture and moxibustion techniques are employed along these
     pathways in order to restore the dynamic equilibrium of yin and yang of
     individuals. Other techniques used to restore balance to the individual are herbal
     medicine, cupping, tui na, dietary advice and qi gong.

4.   The first tenets of TCM evolved and proliferated through out the world and over
     many centuries. This has lead to the development of many subsystems, which are
     loosely described as Asian or Eastern medicine. As a matter of fact, the refinement
     of TCM was also initiated in Europe as well as Asian countries and most recently
     in the United States.

5.   Despite the many adaptations that have evolved over the centuries, the core
     principles remain the same in all medical systems derived from TCM. One of the
     primary principles in TCM is that human life is expressed as a mixture of the
     influence of heaven (yang/energy) and earth (yin/matter) in dynamic equilibrium.

6.   A person who practices TCM must therefore be dedicated to life-long learning,
     rooted in both a material (scientific) understanding of life and a more energetic
     (esoteric) realization of all possibilities.




Mission Statement

The AOM clinical program is designed to integrate the rich history of traditional
Chinese medical methods with the study of modern sciences and the contemporary
practice of acupuncture and oriental medicine.




                                       Page 165
Timelines and Objectives
Each student clinician during his/her career at the Natural Health Clinic demonstrates
competency at numerous clinical skills. One way of keeping track of the progressively
expanding expertise of a student clinician is by a system of skills/performance
evaluations designed to be completed sequentially by term. Here is a time line for all
AOM student clinicians. After each term is completed, the student will receive written
feedback or will meet with their clinic supervisor to discuss how well they have
completed their shift competencies, develop strategies for meeting the student’s needs in
the following quarter and review their progress. The clinic supervisor will sign off for
the competencies they have observed.

There are separate competencies for each observation and clinic intern shift. In general,
the information tracked by the CR regarding patient numbers, shifts, interim and
preceptor hours is not included in these competencies. Students will continue to meet
with the CR and receive written feedback detailing their progress. The purpose of these
Learning Objectives is to evaluate the clinician’s performance of skills required of
acupuncturists, including medical interviewing, physical exams, diagnosis, referral and
assessment, therapeutics and communication skills. Clinicians are encouraged to
complete competencies and have them signed off as the term proceeds. Although not all
of any term’s check-offs must necessarily to be completed in the term, students will be
given a grade of Partial Competency if they drop substantially behind the baseline for
their year or quarter.

During a student’s clinical education the following must be completed:

Observations Objectives
Clean Needle Technique (NCCA) Exam
Clinical Competency One
Clinical Intern Exam
Written
Practical
Preceptorship

Internship Objectives
Acupuncture Intern B Completion
Clinical Competency Two-Six




                                        Page 166
AOM CLINICAL TRAINING - LEARNING OBJECTIVES

Clinical Competency One
Observation I, II, and III

Student Name:                                          Quarter/Year:
Learning Objectives:
Active observation in patient visits
Familiarity with all aspects of clinic operation
Review and practice of the four exams

Supervisor/Initial/Dat       Objective
e
                             Is familiar with and adheres to clinic policy, procedure and
                             flow. Knows procedure for biohazard disposal and CNT.
                             Demonstrates ability to anticipate needed paperwork and have
                             it completed and ready.
                             Has demonstrated the ability to be part of a health care team
                             by actively observing and participating in patient care and
                             follow-up, specifically contributing to the therapeutic protocol
                             being developed by the supervisor and primary clinician.
                             Actively contributing to the diagnosis and case discussions
                             must also be demonstrated.
                             Has demonstrated the ability to properly fill out the dispensary
                             Plan and Instruction Sheet during discussion with Shift
                             Supervisor and primary clinician.
                             Has ensured that the exam room is adequately stocked with
                             items needed during the shift.
                             Has a current Health Care provider's card.
                             Has passed the NCCA Clean Needle Technique course.
                             Has watched the Blood Borne Pathogen Video, and is familiar
                             with OSHA requirements.
                             Is familiar with emergency procedures.
                             Has discussed the above guidelines and met with clinic
                             supervisor to review and set goals.
                             Has passed written Clinic Intern Entry Exam
                             Demonstrates proper understanding of basic skills and
                             techniques during practical portion.
                             Conveys TCM and Western medical information to their
                             patients, supervisors, and colleagues.
                             Has documentation of annual TB test (done at no charge at
                             BCNN) or appropriate follow-up to previous positive test
                             result.


                                          Page 167
AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Two
Internship I, II, III, IV and V
Student Name:                                        Quarter/Year:
Learning Objectives:
Demonstrates self-reliance and thoroughness in performing the four exams.
Chart properly and completely in the SOAP format.
Contribute actively to the diagnostic and therapeutic work up of a client.
Demonstrate competence performing critical technique skills.
Supervisor/Initial/Dat   Objective
e
                         Demonstrates the ability to chart 2 complete patient histories.
                         Demonstrates the ability to safely and effectively perform and record the 4
                         exams.
                         Has contributed to case discussions, pattern differentiation, diagnosis and
                         therapeutic plan.
                         Facilitates time management by anticipating needed paperwork and ensuring
                         adequate room stock.
                         Demonstrates the ability to choose correct needle gauges and sizes most
                         appropriate for the particular patient, condition and therapeutic goal.
                         Demonstrates the ability to perform all the following techniques in a safe,
                         competent manner:
                             Needle insertion with tube
                             Needle withdrawal
                             Six methods of attaining Qi
                             Reinforcing
                             Reducing
                             Fixed cupping
                             Running cupping
                             Indirect moxibustion
                             Rice grain direct moxibustion
                             Warm needle
                             5-Needle Auricular
                             Tui-Na
                             Needle Aishi point
                          Selection, set up and proper placement and monitoring of electroacupuncture
                         Discussed the above guidelines and met with clinical supervisor to review and
                         set goals for quarter.
                         The Acupuncture Intern B (AIB) will perform a minimum of 100 total
                         treatments, including a minimum of 20 first patient interactions (FPI) and 80
                         subsequent patient interactions (SPI) over a minimum a 3 academic quarters and
                         5 clinic shifts.
                         The AIB will meet with the AOM Clinic Director upon completion of all
                         Clinical Competency Two Objectives to determine advancement to Acupuncture
                         Intern A (AIA).
                         Has documentation of annual TB test (done at no charge at BCNH) or
                         appropriate follow-up to previous positive test result.




                                            Page 168
AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Three
Internship VI, VII, VIII

Student Name:                                                Quarter/Year:

Learning Objectives:
1. To expand knowledge and skills in pattern differentiation, diagnosis, 4 exams,
     charting of therapeutic plan and rationale.
2. Be able to formulate treatment programs using Acupuncture, nutrition, Tui Na, Qi
     Gong, and Auriculotherapy.
3. To demonstrate and communicate a preventive view of health assessment to a
     patient using TCM concepts.
     to assume the role of Acupuncture Intern A.

Supervisor/Initial/Dat   Objective
e
                         Has demonstrated the ability to chart the patient’s history competently and
                         completely with adequate communication skills and thoroughness. Can use the
                         appropriate forms for FOC, in-house referrals, and return visits and is able to put
                         these in the proper order in the chart. Can translate, in their charting, what they
                         perceive via inspection, auscultation and olfaction, history-taking, and palpation
                         in accordance with TCM theory.
                         . Establish professional boundaries that maintain compassionate
                         professionalism while avoiding over-familiarity.
                         . Exhibit professional behavior in medical ethics, professional ethics, personal
                         boundaries, proper communication, behavior and dress.
                         . Exemplify personal health and wellness.
                         Demonstrates the ability to perform the following exams within the time allotted.
                          4 Exams (FOC in 30 minutes
                          Front Mu and Back Shu analysis in 15 minutes (or equivalent exam per
                         supervisor)
                          Auricular Point assessment in 10 minutes
                         Listen, observe and palpate the patient properly and use TCM theory to make
                         appropriate diagnoses.
                         Has formulated a treatment plan including the use of:
                             Acupuncture
                             Nutrition (TCM focus)
                             Tui Na
                             Qi Gong
                             Life Style Counseling
                             Auriculotherapy
                         Has discussed the above guidelines and met with clinic supervisor to review and
                         set goals.
                         Additional goals/concerns:




                                              Page 169
AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Four
Internship IX, X, XI

Student Name:                                       Quarter/Year:

Learning Objectives:
1. To improve interviewing and communication skills.
2. To integrate a wellness approach in the context of TCM
3. To be able to develop a treatment plan for 6 cases with follow-up/outcome from the
     list of conditions shown in Clinical Competency Seven.

Supervisor Objective
Initial/Date
             Is able to establish and maintain rapport and          communicate
             professionally with patients as observed
             By clinic supervisor.
             Demonstrates the capacity to prioritize patient’s health concerns and
             discuss general treatment strategies with the patient and clinic supervisor.
             Demonstrate ability to access research information and to critically assess
             the value of published clinical research in the field.
             Has demonstrated the ability to perform and complete all techniques listed
             in Clinical competency Two.
             Re-certify CPR status.
             Has formulated a treatment plan including the use of:
             [For six conditions listed in Clinical Competency Seven]
                 Acupuncture
                 Nutrition (TCM focus)
                 Tui Na
                 Qi Gong
                 Auriculotherapy
             Performed a follow up series for each of these cases (3 treatment
             minimum) and can report on outcome:
             Case A:
             Case B:
             Case C:
             Case D:
             Has presented a case in case review following the SOAP/outcome format.
             Has discussed the above guidelines and met with clinic supervisor to
             review and set goals.
             Additional goals/concerns:




                                       Page 170
AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Five
Internship XII and XIII

Student Name:                                        Quarter/Year:

Learning Objectives:
   1. To achieve competency in all basic acupuncture skills.
   2. Demonstrate basic skills in pattern discrimination and diagnosis.
   3. To demonstrate a basic use of TCM therapeutics.
   4. To demonstrate good overall patient management ability.

Supervisor Objective
Initial/Date
             Has continued to demonstrate the ability to perform competently all
             acupuncture techniques listed in Clinical competency two.
             Has demonstrated good time management skills completing SPI in 60
             minutes and FPI in 90 minutes.
             Articulate the underlying pathophysiology of applied TCM
              Exhibit familiarity with Chinese medical classics and use the classical
             principles and teachings in their TCM skill.
             Utilize the rich heritage of traditional Chinese medicine and treat it as the
             guiding force in diagnosis and treatment.
              Students will be immersed in, and infused with, the holistic concepts
             embodied within TCM theory.
             Demonstrates the ability to gather pertinent information, perform the 4
             exams, synthesize a diagnosis and devise, implement and monitor a
             treatment plan for patients. The clinic supervisor will have worked with
             the clinician on 5 different cases:
             Case A:
             Case B:
             Case C:
             Case D:
             Case E:
             Demonstrates the ability to recognize and implement (with follow-up) 5
             cases for referral.
             Has discussed the above guidelines and met with clinic supervisor to
             review and set goals.
             Has discussed and demonstrated skills required for operating at TCM
             practice.




                                        Page 171
AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Six
Internship XIV

Student Name:                                        Quarter/Year:
Learning Objectives:
 1. To consolidate clinical skills
 2. Demonstrate basic skills in pattern discrimination and diagnosis.
 3. To demonstrate a basic use of TCM therapeutics.
 4. To demonstrate good overall patient management ability.
Supervisor Objective
Initial/Date
             Has demonstrated the ability to perform and evaluate all remaining
             examinations.
             Has continued to demonstrate good time management in all situations
             including acute illness.
             Has demonstrated successful ability to write a referral letter to another
             practitioner.
             Has shown initiative in seeing the need to call a patient to follow up/check
             in, after receiving permission from the clinic supervisor.
             Listening and intuitive skills: Transfer intuition into their TCM techniques
             Demonstrates continued expansion of abilities with regard to gathering
             information, synthesizing a diagnosis, and has developed treatment plans
             for 5 different cases. Has seen these patients since the initial protocol,
             made adjustments as needed, and has discussed long term goals with the
             patient and clinic supervisor:
             Document the effects of any applied modality to determine and predict
             therapeutic outcome.
             Case A:
             Case B:
             Case C:
             Case D:
             Case E:
             Demonstrates good therapeutic integration as evidenced by therapeutic
             plans that consistently integrate different TCM modalities and reflect some
             aspect of wellness care. Provide health prevention measures based upon
             traditional Chinese medicine (such as Tai Chi, Qi Gong, and dietary
             guidelines) to support the well-being of their patients.
             Has discussed and demonstrated skills required for operating a TCM
             practice.
             Additional Goals/Concerns:

              Has documentation of annual TB test (done at no charge at BCNH) or
              appropriate follow-up to previous positive test results.

                                       Page 172
Page 173
AOM CLINICAL TRAINING – LEARNING OBJECTIVES
Clinical Competency Seven
Categories of Disease/Conditions for Therapeutic Plans

Student Name:                                           Quarter/Year:
Categories of Western disease/conditions for which TCM therapeutic plans are to be
developed (Competency Four). The plan should include at least one series of three return
visits as well as a plan for long-term management if appropriate. Students should attempt
to see the full list of disease/conditions signing off as they proceed.

Supervisor Disease/Condition
Initial/Date
             Cough and Asthma
             Insomnia
             Headache
             Common Skin Disorder
             Low Back Pain
             Anxiety/Stress
             Nicotine Addiction
             Fatigue
             Cold/Flu
             Sinusitis/Rhinitis
             Diarrhea
             Constipation




                                       Page 174
Clinical Competencies – Nutrition
Nutrition Department
Learning Objectives and Competencies for Secondary Clinicians
Clinic Practicum 1

Objectives
1. Develop familiarity with all aspects of clinic operations.
2. Work as a team for consultation management and nutritional interventions.
3. Extract and summarize critical nutritional information from the medical record
     to effectively interview the patient.
4. Actively participates with patient interviews and education.
5. Formulate individualize nutritional plan of care for the patient.
6. Develop effective chart documentation skills.

Objective                      Competency                                    Supervisor
                                                                             Initial/Date
Develop familiarity with all   Reads Student Clinician Handbook.
aspects of clinic operations
                               Becomes familiar with chart retrieval
                               procedures.
                               Becomes familiar with clinic forms,
                               nutrition handouts and teaching aids.
                               Reviews schedule of appointments.
                               Receives tour of clinic.
                               Attends preview and review in the ND
                               department (if available.)
Work as a team for             Actively participates in preview and review
consultation management        every clinic shift.
and nutrition interventions
                               With the primary as the lead, effectively
                               assist with interviewing and providing
                               individualized nutrition education to the
                               patient.
                               Accurately obtains patient weight, height,
                               and wrist circumference.
                               Prepares appropriate handouts and teaching
                               aids for the primary.
                               Completes team recommendation form,
                               photocopies for chart, and reviews with the
                               patient.
                               Completes the superbill and obtains
                               supervisor’s signature.




                                        Page 175
Objective                   Competency                                          Supervisor
                                                                                Initial/Date
Extract and summarize       Accurately reviews patient medical record for
critical nutritional        chief complaint, established plan of care (if
information from the        available), demographics, anthropometic data,
medical record to           laboratory data, medications/supplements/herbs,
effectively interview the   known allergies.
patient
                            With the primary as the lead, effectively present
                            the patient case during preview.
Participate with patient    Develops rapport with the patient.
interviews and
education.
                            Makes eye contact with the patient.
                            Communicates in an appropriate and effective
                            manner with patients, students, supervisors, and
                            other staff.
                            With the primary as lead, provide nutrition
                            education to the patient that is individualized,
                            culturally appropriate, and within the overall
                            treatment plan for the patient.
Formulate individualize     Correctly performs calculations necessary for
nutritional plan of care    the Objective portion of the SOAP note.
for the patient.
                            With the primary as lead, effectively develops
                            an individualized nutrition care plan for the
                            patient that is based on medical record and
                            interview information.
                            With the primary as lead, effectively present the
                            nutrition plan of care for the patient during
                            review.
Develop effective chart     Completes a minimum of 5 practice SOAP
documentation skills.       notes during the quarter.




                                         Page 176
Nutrition Department
Learning Objectives and Competencies for Primary Clinicians
Clinic Practicum 2 and 3

Objectives
Develop ability to function independently during patient visits.
Independently develop nutrition care plans that are individualized and reflect realistic
short-term and long-term goals of the patient.
Conduct a thorough, timely, and comprehensive nutrition interview.
Provide individualized nutrition education.
Develop professional skills when interacting with patients, supervisors, staff, and peers.
Write competently and completely in chart notes, communications with referring
providers, and patient referrals.
Demonstrate good overall patient management ability.

                                                                                 Supervisor
Objective                            Competency                                  Initial/Date
Develop ability to function          Utilize time efficiently in preview,
independently during patient         actual counseling appointment time
visits.                              with patient, and review sessions.
                                     Complete work in a timely and
                                     orderly manner.
Independently develop nutrition      Demonstrate the ability to create an
care plans that are individualized   organized approach in treatment
and reflect realistic short and      related interviews.
long-term goals of the patient.
                                     Individualize nutrition care plans
                                     Incorporate patient’s beliefs, daily life
                                     patterns, and socioeconomic
                                     circumstances into nutrition
                                     recommendations.
                                     Incorporate the rich history of
                                     culturally diverse and traditional diets
                                     into meal planning.
                                     Demonstrate the ability to effectively
                                     comprehend clinical data from the
                                     medical record.
                                     Obtain information needed for a
                                     thorough assessment (weight, diet,
                                     histories, exercise level, medications,
                                     labs, etc.)
                                     Use professional resources (text, food
                                     tables, computer, etc.) appropriately to
                                     complete assessments in a timely
                                     manner.

                                        Page 177
Objective                       Competency                                  Supervisor
                                                                            Initials/Date
                                Complete accurate calculations.
                                Assess patient’s readiness to learn and
                                barriers to learning.
                                Determine need for follow-up
                                appointments.
Conduct a thorough, timely,     Apply nutrition therapies for
and comprehensive nutrition     disease/health management.
interview.
                                Recommend appropriate nutritional
                                therapies with specific
                                recommendations.
                                Appropriately prioritize patient’s
                                nutritional concerns.
                                Determine goals and desired outcomes
                                in conjunction with the patient.
                                Maintain control of the session.
                                Assess and prioritize other concerns that
                                are not necessarily nutritional.
                                Effectively probe problem areas in the
                                patient’s diet and lifestyle.
Provide individualized          Integrate new scientific knowledge into
nutrition education.            individualized medical nutrition therapy
                                recommendations to the patient.
                                Accurately answer the patient nutrition
                                questions and concerns.
                                Select appropriate education materials
                                for the patient.
                                Closes session by summarizing goals,
                                action plans, and answering questions
                                for the patient.
                                Present and evaluate nutrition education
                                classes when applicable (i.e. Smoking
                                Cessation Program, etc.)
Develop professional skills     Communicate in an appropriate,
when interacting with           effective and professional manner when
patients, supervisors, staff,   dealing with patients, students,
and peers.                      supervisors, and other staff.
                                Observe the policies and procedures of
                                the clinic.




                                Page 178
Objective    Competency                                Supervisor
                                                       Initial/Date
             Demonstrate positive work relationships
             and attitude.
             Demonstrate respect and dignity to
             others.
             Maintain professional appearance.
             Demonstrate initiative.
             Maintain punctuality and attendance.
             Complete assignments as scheduled.
             Work as a team player.
TB testing   Has documentation of annual TB test
             (done at no charge at BCNH) or
             appropriate follow-up to precious
             positive test result.




                   Page 179
Objective                              Competency                                Supervisor
                                                                                 Initial/date
Write competently and completely in    Communicate verbally and in writing to
chart notes, communications with       referring practitioners when
referring providers, and patient       appropriate.
referrals.
                                       Note: this competency appears again
                                       with next objective.
                                       Chart properly and completely in SOAP
                                       format.
Demonstrate good overall patient       Encourage whole foods approach to
management ability.                    meal planning.
                                       Refer patients to other dietetic
                                       professionals when a situation is
                                       beyond one’s level of competency (i.e.
                                       renal, nutrition support, etc.)
                                       Communicate verbally and in writing to
                                       referring practitioners when
                                       appropriate.

                                       Note: this competency appears again
                                       with previous objective.
                                       Consult other disciplines as
                                       appropriate.

To achieve a grade of AC for the Clinical Practicum 3, primary clinicians must achieve
all of the clinical competencies by the end of their last quarter.




                                       Page 180
Bastyr Center for Natural Health
Nutrition Department Chart Documentation Standards

SOAP Format

Subjective (observations, statements, opinions)
 1. Information provided by the patient, family and/or significant other or healthcare
     team member.
 2. Patient reported nutrition history: appetite, meal pattern, N/V/D, allergies or
     sensitivities, smell and taste problems/changes,
 3. Patient reported weight history
 4. Cultural practices: Religious, preferences, avoidance, beliefs that impact food
     intake.
 5. Socioeconomic information: transportation, money, cooking facilities, food storage,
     food assistance programs, shopping location, family members.
 6. Nutrition Practices: FFQ, 24-hour recall, food diary or record; meal pattern;
     avoided foods; special diets; cravings; supplements
 7. Physical activity, exercise levels.
 8. Stress and Energy levels.
 9. Stage of Behavior Change.
 10. OTC medications not prescribed

Objective (factual information)
1. Age, ethnicity, and gender
2. Height, weight, and weight gain patterns
3. Laboratory data
4. Diet order
5. Anthropometric data (IBW, %IBW, BMI, %UBW)
6. Desirable weight or realistic goal
7. Pertinent medications/supplements/herbs
8. Calculations of nutrient needs

Assessment (clinician’s evaluation)
 1. Overall impression of the patient’s nutrition status based on the Subjective and
     Objective data.
 2. Information supporting the overall impression:
          a. Nutrition intake and history: assess calories, protein, vitamins, minerals,
              fluids, fiber, meal pattern.
          b. Current weight and weight history.
          c. Laboratory data.
          d. Exercise-patterns, stress levels.
          e. Behaviors influencing nutrition, and readiness to change.
          f. Socioeconomic, psychosocial, and cultural barriers influencing nutrition.
3.   Evaluation of nutrition education needs.
4.   Assessment of understanding of recommendations and education given.

                                       Page 181
5.    Anticipated barriers/problems with adherence. Assessed motivation and
receptiveness.

Plan (actions addressing the assessment)
1. Overall GOALS for nutrition therapy (measurable outcomes).
2. Every item in the plan is linked to the Assessment.
3. Treatment plans agreed to w/client (measurable).
4. Recommended changes in diet orders, MVI, supplements.
5. Recommended labs, testing, referrals.
6. Follow-up plans (next appointment).




                                      Page 182
EXIT EXAMINATION FOR GRADUATING CLINICAL/COUNSELING TRACK
NUTRITION STUDENTS

A graduation requirement for students in the Counseling/Clinical track is an exit
examination. The exit examination will be in two parts. If you pass one part but not the
other, you will only need to repeat the part you did not pass, not both parts. However,
both parts need to be passed to meet the requirements for graduation.

First Part
The first part of the examination will be a component of the requirements for passing
Clinic Practicum 3. This shift would usually be completed in Spring quarter but some of
you will complete this shift in Winter quarter and some later than Spring.

The examination will consist of an evaluation of a FOC or FOC2 with you as the
primary. You will be notified, in writing, within two weeks of your completing the first
part of the exit examination whether you passed. If you fail this part of the exit
examination, another clinic faculty member will independently view the videotape. If
your supervisor and other faculty independently give a failure grade, you will need to
repeat Clinic Practicum 3 and also repeat the videotaped patient contacts.


Second Part
The second part of the exit examination will be an open book written examination. The
examination will be three hours in length, be open-book, and will consist of three case
studies. We will provide some aspects of the “S” and “O” of a “SOAP” note and you
will complete the “SOAP” note.

The written part of the exit examination will only be offered, if necessary, in the
examination period for that quarter. That means that if you fail the second part of the
exit examination, you will need to wait until the end of the following quarter to retake the
exam. Both parts of the exit examination will be graded as Pass/Fail. You will not be
able to look at your videotape or written exam as the exit examination is for evaluation
purposes only.

If you do not pass either part of the exit examination, and you meet all the other
requirements, you will still be able to “walk” in the June graduation ceremony. Of
course, you will not receive your diploma until all graduation requirements are met.




                                        Page 183
PRINCIPLES OF NATUROPATHIC MEDICINE



The Healing Power of Nature [Vis Medicatrix Naturae] Naturopathic medicine
recognizes an inherent ability in the body which is ordered and intelligent. Naturopathic
physicians act to identify and remove obstacles to recovery and to facilitate and augment
this healing ability.

Identify and Treat the Causes [Tolle Causam] The naturopathic physician seeks to
identify and remove the underlying causes of illness, rather than to eliminate or merely
suppress symptoms.

First Do No Harm [Primum Non Nocere] Naturopathic Medicine follows three
principles to avoid harming the patient: 1) utilize methods and medicinal substances
which minimize the risk of harmful side-effects; 2) avoid, when possible, the harmful
suppression of symptoms; 3) acknowledge and respect the individual’s healing process,
using the least force necessary to diagnose and treat illness.

Doctor as Teacher [Docere] Naturopathic physicians educate the patient and encourage
self-responsibility for health. They also acknowledge the therapeutic value inherent in
the doctor - patient relationship.

Treat the Whole Person Naturopathic physicians treat each individual by taking into
account physical, mental, emotional, genetic, environmental, social and other factors.
Since total health also includes spiritual health, naturopathic physicians encourage
individuals to pursue their personal spiritual path.

Prevention Naturopathic physicians emphasize the prevention of disease, assessing the
risk factors and hereditary susceptibility to disease and making appropriate interventions
to prevent illness. Naturopathic Medicine strives to create a healthy world in which
humanity may thrive.

Wellness Naturopathic medicine seeks to establish and maintain optimum health and
balance, wellness is a state of being healthy, characterized by positive emotion, thought
and action. Wellness is inherent in everyone, no matter what dis-ease(s) is/are being
experienced. If Wellness is really recognized and experienced by an individual, it will
more quickly heal a given dis-ease than direct treatment of the dis-ease alone. (This
principle was adopted by Bastyr University and added to the six principles.)




                                        Page 184
Clinical Competencies – Naturopathic Medicine

Mission Statement:
To train naturopathic physicians who are imbued with an understanding of how to
clinically apply the healing power of nature and the principles of Naturopathic
Medicine.

ND LEARNING OBJECTIVES FOR SECONDARY CLINICIANS

Timelines and Objectives
Each student clinician during his/her career at the Natural Health Clinic demonstrates
competency at numerous clinical skills. One way of keeping track of the progressively
expanding expertise of a student clinician is by a system of skills/performance
evaluations designed to be completed sequentially by term. The following is a time line
for all ND student clinicians. After each term is completed, the student will receive
written feedback or will meet with their clinic supervisor to discuss how well they have
completed their shift competencies, develop strategies for meeting the student’s needs in
the following quarter and review their progress. The clinic supervisor will sign off for
the competencies they have observed.

Quarter 1
Active observation during patient visits.
Familiarity with all aspects of clinic operation.

Quarter 2
Review and practice of history and PE skills.
Present cases at preview and review.

Quarter 3
Chart properly and completely in the SOAP format.
Contribute actively to diagnostic and therapeutic work-up of patient cases.
Begin, at supervisor's discretion, limited primary work.




                                         Page 185
LEARNING OBJECTIVES FOR PRIMARY CLINCIANS

Quarter 4 and 5
Expand knowledge and skills in the interview, PE, differential diagnosis, treatment and
charting.
To formulate basic plans utilizing nutrition, homeopathy, counseling, botanical medicine
and physical medicine and explain the rationale for each item in plan to the supervising
physician and the patient.
Quarter 6
Suggest probable etiologies underlying a particular diagnosis.
To demonstrate and communicate a preventive view of health assessment to a patient.

Quarter 7 and 8
To demonstrate good overall patient management ability.
To develop holistic therapeutic plans and long term case management plans.
To develop the ability to function independently during follow up visits, developing
treatment plans with minimal assistance from the supervising doctor.

ND CLINICAL COMPETENCIES

During your clinical training at the Natural Health Clinic of Bastyr University, you
are required to demonstrate competency with numerous clinical skills. Those skills
begin with the secondary skills and advance to the primary skills, each building
upon the next.
The competencies are listed on the sheets following this introduction. You must
have each sheet signed off by your supervising physician, keep a copy for yourself
and turn the original in to the clinic registration staff to prove completion.
Following, you will find the clinical competencies for secondary clinicians and
primary clinicians and the timelines we suggest you follow in order to complete
them in time for graduation.

All secondary competencies must be signed off before a clinician may advance to
primary status. All primary competencies must be signed off before a primary may
graduate.




                                       Page 186
All primary clinicians must demonstrate competency in performing all physical exams
and in diagnosis and treatment of a list of conditions. Following this condition you will
find a sign off sheet for the exams, lists of steps to be included in the exams and the sign
off sheet for the conditions.
These competencies are not linked to the clinic shift grades. They are a separate
requirement, and a signed-off competency does not assure a grade of AC on any clinic
shift.
Secondary Clinicians:
Clinical Competencies for Secondary Clinicians
Clinical competencies, quarters 1-3, secondary clinicians
Clinical competency # 3 – Physical Medicine
Clinical competency # 5 – Counseling
Clinical competency # 6 – Dispensary
Clinical Competencies for Primary Clinicians
Clinical competencies, quarters 4-8 primary clinicians
Clinical competencies, Conditions
Clinical competencies, Examinations
Clinical competency #4 - Physical Medicine
Elective competencies – Homeopathy




                                         Page 187
SECONDARY COMPETENCIES [Clinical Competency #2]
Competency   Quarter 1      Quarter 2           Quarter 3
Student                    Supervisor   Comment   Supervisor   Comments   Supervisor   Comments
                           Signature/             Sig/Date                Sig/Date
                           Date
1. Is familiar with
and adheres to clinic
policy, procedures,
and flow. Knows
procedure for
biohazard disposal,
speculums, cervical
cap, diaphragm, ear
lavage equipment.
2. Demonstrates
ability to anticipate
needed paperwork
and have it
completed/ready: lab
forms for Pap’s, lab
requisition forms,
release of records
form, diet diaries, and
is able to find specific
protocols for patients
upon request.
3. Demonstrates the
ability to be part of a
health care team by
actively observing and
participating in
patient care and
follow up, specifically
contributing to the
therapeutic protocol
being developed by
the supervisor and
primary clinician, and
contributing to the
differential diagnoses
or problem list in case
discussion
4. Demonstrates the
ability to properly fill
out the dispensary
plan and instruction
sheet during
discussion with the
supervising doctor
and primary clinician.




                                             Page 188
Competency                Quarter 1              Quarter 2               Quarter 3
Student                   Supervisor   Comment   Supervisor   Comments   Supervisor   Comments
                          Signature/             Sig/Date                Sig/Date
                          Date
5. Ensure the exam
room is adequately
stocked with items
needed during the
shift.
6. Has a current CPR
card/Emergency
responder card.
7. Demonstrates an
understanding of how
to integrate the
traditional modalities
of naturopathic
medicine (herbology,
physiotherapy,
hydrotherapy,
nutrition,
homeopathy, life style
modifications) into
general treatment
plans
8. Demonstrates an
understanding of the
principles and
heritage of
naturopathic
medicine.
9. Understands and
applies the therapeutic
order in the care of
patients.
10. Is familiar with
emergency procedures
manual and knows the
location of the
emergency box and
oxygen tank and how
to use the contents.
11. Demonstrates the
ability to present the
appropriate
information at case
preview and case
review in SOAP
format and utilizing
appropriate medical
terminology.




                                            Page 189
                                          Revised 4/16/02
Competency                Quarter               Quarter                  Quarter
                          1                     2                        3
Student                   Supervisor   Comment   Supervisor   Comments   Supervisor   Comments
                          Signature/             Sig/Date                Sig/Date
                          Date
12. Able to assess and
identify
pertinent/relevant
patient findings and
life style
modifications.
13. Demonstrates
communication skills,
which emphasize
patient needs and are
sensitive to patient
lifestyle, gender,
culture, and
socioeconomic status.
14. Reads charts and
prepares for patient’s
visits prior to case
review.
15. Demonstrates the
ability to chart and
complete patient visits
in SOAP format.
16. Is able to explain
lab requirements to a
patient, including the
purpose of the test
specimen collection
technique, any dietary
modification required,
and anticipated length
of time before results
are available, and
associated billing
specifications.
17. Has
documentation of
annual TB test (done
at no charge at
BCNH) or appropriate
follow-up to previous
positive test result




                                            Page 190
PRIMARY COMPETENCIES [Clinical Competency #1]
Competency    Quarter           Quarter                                Quarter
              4/5               6/7                                    8
                             Sup        Comment   Sup        Comments Sup        Comments
                             Sig/Date             Sig/Date            Sig/Date
1. Demonstrates the
ability to chart
competently in SOAP
format. Complete the
patient's history with
adequate communication
skills and thoroughness,
uses appropriate forms
for FOC and in house
referrals, and puts in
proper order in the chart.
Possesses Charting
Skills
Chart chief complaint
focused with 7 attributes
and detailed description
of symptoms.
Utilize SOAP format.
Use proper terminology
and medical language.
Properly discuss the role
and the application of
the principles of
naturopathic medicine in
writing including
assessment and
rationale.
Chart legibly with
grammatically correct
summaries of the patient
visit.
Demonstrate an ability
to complete all clinical
forms accurately.

2. Demonstrates the
ability to perform a
whole person analysis
for health and risk
factors.
3. Listens to the
patient’s narrative and
always tries to
understand the root
cause of each
patient’s condition.
Competency                   Quarter              Quarter              Quarter
                             4/5                  6/7                  8

                                            Page 191
                          Sup        Comments   Sup        Comments   Sup        Comments
                          Sig/Date              Sig/Date              Sig/Date
4. Incorporates the
Naturopathic
Principles into the
patient interview.
5. Is able to establish
and maintain rapport
and to communicate
professionally with
patients as observed
by supervising doctor.
 6. Understands
medical information
and shares that
information with
patients in terms that
they can understand.
7. Demonstrates the
capacity to prioritize
patients’ health
concerns, including
the need for referral
and treatment
strategies, with the
patient and
supervising doctor.
8. Presents all
considered medical
interventions with
respect to cost/benefit
analysis.
9. Demonstrates the
capacity to do
appropriate lifestyle
counseling including
Safer Sex.
10. Demonstrates an
ability to conduct
medical research
using printed and
electronic sources and
demonstrates
familiarity with
medical journals and
standard textbooks.




                                         Page 192
                                            Revised 4/16/02
Competency               Quarter            Quarter              Quarter
                         4/5                6/7                  8
                         Sup        Comment Sup        Comments Sup        Comments
                         Sig/Date           Sig/Date            Sig/Date
11. Determines and
conducts appropriate
physical exams and
conveys the clinical
relevance of these
exams to supervising
doctor.
12. Possesses
sufficient knowledge
of the safety of every
treatment prescribed.
13. Tracks the effects
of applied
interventions.
14. Recertified CPR
status (current CPR)
15. Has
documentation of
annual TB test (done
at no charge at
BCNH) or appropriate
follow-up to previous
positive test result.
16. Has presented in
case review following
the SOAP/outcome
format.
17. Has demonstrated
good time
management skills,
completing a ROC in
45 minutes and a FOC
in 75 minutes.




                                        Page 193
PRIMARY COMPETENCIES - Continued [Clinical Competency #1]
Competency   Quarter           Quarter            Quarter
             4/5               6/7                8
                             Supervisor   Comment   Supervisor   Comment   Supervisor   Comment
                             Sig/Date               Sig/Date               Sig/Date
Competencies                 Q 4/5                  Q 6/7                  Quarter 8
18. Has demonstrated
B-12 intramuscular
injection
19. Has demonstrated
successful ability to
write a referral letter to
another physician
specialist.
20.Has demonstrated
ability to write a
treatment summary
letter to referring
physician (patient’s
primary care
physician).
21. Has shown
initiative in seeing the
need to call a patient to
check in after receiving
permission from the
supervising doctor.
22. Has completed
transfer of assigned
patients to secondary
student clinicians
during the last patient
care shift.
23. Has completed 1
chart summary for a
clinic patient with
multiple visits (8-10)
over at least a 1-year
period.
24. Has fit either a
cervical cap or
diaphragm on a patient
or student model.
25. Has demonstrated
initiative in researching
patient cases.




                                               Page 194
Competency                  Quarter                Quarter                Quarter 8
                            4/5                    6/7
                            Supervisor   Comment   Supervisor   Comment   Supervisor   Comment
                            Sig/Date               Sig/Date               Sig/Date
Competencies                Q 4/5                  Q 6/7                  Quarter 8
26. Demonstrates
competency in
interpreting findings
from laboratory,
radiographic and other
tests.
27. Demonstrates
initiative and
competency in
determining relevant
additional diagnostic
testing.
28. Develops trust in
their intuitive knowing
and demonstrates the
ability to articulate and
incorporate their
intuitive process into
the decision-making of
clinical management.
29. Effectively utilizes
and integrates multiple
methodologies and/or
modalities within the
care of any particular
patient.
30. Demonstrates
competency in
assessing probable
etiology and processes
underlying diagnoses in
discussion and in
charting.
31. Understands and
models appropriate
professionalism in the
context of intimate
modalities and
conversations.
32. Acts within ethical
parameters.
33. Understands and
appreciates personal
health and wellness.




                                              Page 195
Competency                Quarter                Quarter                Quarter
                          4/5                    6/7                    8
                          Supervisor   Comment   Supervisor   Comment   Supervisor   Comment
                          Sig/Date               Sig/Date               Sig/Date
Competencies              Q 4/5                  Q 6/7                  Quarter 8

35. Understands CPT
and ICD-9 coding and
demonstrates this
knowledge in billing
and charting.
36. Demonstrates an
understanding of
naturopathic and
professional
organizations and their
function in the
profession.




                                            Page 196
      ND CLINICAL COMPETENCIES

      PRIMARY CLINICAL COMPETENCIES – CONDITIONS

      Categories of disease/conditions for which holistic therapeutic plans are to be developed
      (beginning with clinical competency four. The therapeutic plan should include at least 1
      follow up visit as well as future plan indicating long-term management goals.

Supervisor      Competency
Initial/Date
                Cardiovascular disease: e.g. HTN, hypercholesterolemia, coronary artery disease,
                angina, etc.
                Dysglycemia: e.g. diabetes or hypoglycemia
                Food Allergies/Intolerances
                Upper gastrointestinal disorder: e.g. GER, GERD, PUD, dyspepsia
                Lower gastrointestinal disorder: e.g. IBD, IBS, Crohn’s, UC, constipation, diarrhea
                Hepatobiliary disease: e.g. cholelithiasis, hepatitis, metabolic liver disease
                Cancer prevention and/or treatment
                Skin diseases
                Arthritis or myalgia (long term)
                Anemia
                Osteoporosis or osteopenia
                Gynecological conditions: e.g. FBD, menopausal management/PMS or
                dysmenorrhea, endometriosis, polycystic ovary disease, management of abnormal pap
                smear
                Male genitourinary conditions: e.g. prostate disorder, epididymitis, varicocele
                Acute Respiratory Tract Disorder: e.g. otitis media, strep throat
                Chronic Upper Respiratory Tract Disorder
                Asthma
                Nutritional deficiencies
                Urinary tract and/or kidney disorders: e.g. UTI, pyelonephritis, glomerulonephritis
                Mental/emotional illness
                Nervous system disorder: e.g. insomnia, dizziness, seizure
                HIV: e.g. opportunistic infections associated with HIV+, also HIV risk assessment
                Endocrine disorders
                Musculoskeletal conditions - acute
                Musculoskeletal conditions - chronic




                                              Page 197
      ND CLINICAL COMPETENCIES
        CHECK-OFF OF PHYSICAL EXAMS TO BE PERFORMED BY CLINICIANS
            List of Physical Exams to be Performed by Clinicians
Sup/       Exam
Initial
Date
            Gynecological Exam - breast (in 10 minutes)
            Gynecological Exam - pelvic (in 20 minutes)
             Male Reproductive Exam including prostate (in 20 minutes)
             Well Child Check-up including developmental mile-stone assessment (in 20 minutes)
             Complete 72 Multistep exam (in 30 minutes) (also referred to as 72-step exam
             HEENT Exam
             Abdominal Exam
             Respiratory Exam
             Cardiovascular Exam
             Musculoskeletal Exam
             Neurological Exam

      The steps of each exam are listed in Physical Exam Outline. The exams are to be
      performed from memory and observed in full by the supervising doctor. Clinicians are
      encouraged to complete their exams well in advance of their last patient care shift. A
      copy of this page is given to the Clinic registration staff upon completion.




                                             Page 198
       CLINICAL COMPETENCY THREE
       (Physical Medicine Competency One)
       (Secondary Clinician Objectives)

       Mission Statement: To offer specialized care in physical medicine modalities in an
       atmosphere of excellence, professionalism and compassion, while simultaneously
       developing these skills and attributes in naturopathic medicine student clinicians.

       Student Name:                                             Quarter/Year:
       Clinical Competencies:
        1. Demonstrates ability to perform listed hydrotherapy treatments
        2. Demonstrates ability to perform listed physiotherapy treatments
        3. Demonstrates soft tissue assessment and treatments

Supervisor/     Objective
Initial/Date
                Possesses charting skills focused on chief complaint with full 7 attributes and detailed
                recording of symptom presentation in their charting.

                Understands and models appropriate professionalism in context of intimate modalities.
                Models sensitivity to patients’ comfort level, issues around modesty and physical
                touch. Students will establish professional boundaries that maintain compassionate
                professionalism while avoiding inappropriate behavior.
                Strives to optimize fitness in order to do the physical work required in physical
                medicine.
                Recognizes the importance of Physical Medicine historically in Naturopathic Medicine
                Demonstrates appropriate paperwork, charting and actions regarding receiving and
                issuing referrals.
                Actively diagnoses each complaint at every visit in order to initiate indicated referrals.
                Develops general treatment plans inclusive of Physical Medicine on all Naturopathic
                Medicine shifts.
                HYDROTHERAPY TREATMENT
                Constitutional Hydrotherapy
                a. technique
                b. primary indications
                c. contraindications
                Hyperthermia
                a. technique
                b. primary indications
                c. contraindications
                Wet Sheet Pack
                a. technique
                b. primary indications
                c. contraindications


                                               Page 199
Supervisor/    Objective
Initial/Date
               Colon Irrigation
               a. technique
               b. primary indications
               c. contraindications
               Local Contrast
               a. technique
               b. primary indications
               c. contraindications
               Other Office and Home treatments (Heating compress (wet sock), neutral bath, Epsom
               salts soak, contract showers, other contract applications)
               a. technique
               b. primary indications
               c. contraindications
               PHYSIOTHERAPY
               Diathermy
               a. technique
               b. primary indications
               c. contraindications
               Ultrasound
               a. technique
               b. primary indications
               c. contraindications
               Low Volt EMS
               a. technique
               b. primary indications
               c. contraindications
               Interferential
               a. technique
               b. primary indications
               c. contraindications
               Galvanic/Iontophoresis
               a. technique
               b. primary indications
               c. contraindications
               Soft Tissue Assessment
               a. tissue texture evaluation
               b. muscle tension evaluation
               c. active/passive joint range of motion
               Local Tissue Release Techniques
               a. NMT
               b. Swedish massage techniques


                                           Page 200
Supervisor/    Objective
Initial/Date
               c. cross fiber
               d. positional release
               Muscle Energy Stretching Technique
               a. lower extremity/low back
               b. upper extremity/neck/shoulders
               a. lower extremity/low back
               b. upper extremity/neck/shoulders




                                          Page 201
ND CLINICAL COMPETENCY THREE
(Visceral Manipulation Clinic)

(Optional Shift)

Student
Name_________________________________Quarter/Year______________________

Visceral Manipulation is based on the concept that all of the viscera in the body are
mobile and need to be able to move in an unrestricted fashion in order to allow proper
function. Using gentle manipulative techniques to release restriction, adhesions, etc.
enhance organ function and mobility can be restored. This shift will focus on the GI tract
as a follow up to the seminar taught by Dr. W. Pole in March 2001. That course will
cover the abdominal organs.

   Initial/        Objective
   Date
                   Performs global, general and local listening as part of the diagnostic
                   process
                   Evaluate and treat the liver – discern the 3 plane of motility – know
                   the attachments - manipulate
                   Ability to access and treat the gall bladder
                   Evaluate and treat the stomach – identify options of this organ and
                   what attachments might be restricting its movement – ability to open
                   pyloric sphincter
                   Evaluate and treat the small intestine – identify D1, D2, D3 and root
                   of the mesentery –locate the duodenal/jejunal junction
                   Evaluate and treat the colon – identify the ileocecal valve,
                   ascending/descending segments and flexures




                                           Page 202
ND CLINICAL COMPETENCY FOUR

Physical Medicine Two (Primary Clinician Objectives)

Student Name:                                                 Quarter/Year:
Clinical Competencies:
Demonstrates use of orthopedic tests
Demonstrate use of neurological tests
Demonstrate ability to assess joint dysfunction due to subluxation through motion
palpation
 Demonstrate ability to reach a working diagnosis, prescribe and administer appropriate
treatment including hydrotherapy, physiotherapy, soft tissue manipulation, joint
manipulation, nutrition, botanicals and homeopathy.
Supervisor       Objective
Initial/Date
                 Orthopedic Assessment
                 a. knee
                    . Ant /Post draw sign
                    . Apley’s compression/distraction
                    . patella femoral grind
                    . apprehension test for partella dislocation
                    . valgus and virus stress test
                 b. hip/pelvis
                    . trendelenburg
                    . test for leg length discrepancy
                    . Patrick test
                 c. SI/low back
                    . straight leg raise
                    . valsalva
                 shoulder
                 . Apley’s scratch test
                 neck/thoracic outlet
                 . Adson’s/Reverse Adson’s
                      . Wright’s test
                      . Costoclavicular
                 f. ankle/foot
                      . anterior draw sign
                      . tibial torsion test
                      . dorsiflexion
                       . Homan’s sign
                 g. elbow
                 h. wrist/hand
                     . phalen’s
                     . tinel’s sign

                                       Page 203
Supervisor     Objective
Initial/Date
               Neurological Assessment
               a. reflexes
               b. Romberg
               c. Babinski
               d. muscle strength
               e. sensation
               Joint Fixation Assessment
               a. static palpation
               b. motion palpation
               c. contraindications to joint manipulation
               Appropriate Physical Medicine Prescription/Treatment
               a. nutritional support
               b. botanical/homeopathic
               c. hydrotherapy
               d. physiotherapy
               e. soft tissue manipulation
               f. joint manipulation set up
               g. joint manipulation
               GENERAL PHYSICAL MEDICINE SKILLS
               Has developed palpatory literacy
               Has developed confidence to continue care when no diagnosis has been
               reached.
               Understands and evaluates the effect of interventions on the underlying
               pathophysiology.
               Possesses awareness of each intervention (details) and, with on-going
               experience, comparatively analyzes the interventions producing the most
               satisfactory outcomes.

               Documents the effects of any applied modality to determine and predict
               therapeutic outcome.
               CAREER MANAGEMENT
               Has developed awareness of costs of therapeutic devices and of their required
               upkeep
               Learns logistics of room (number, size, type, etc.) needed for Physical Medicine
               practice
               Has learned scheduling and time management issues surrounding a Physical
               Medicine-based practice.
               Has developed a simple, small-scale start-up plan for Physical Medicine
               practice within context of general Naturopathic Medicine practice.




                                     Page 204
Homeopathic Medicine Department
Bastyr Center for Natural Health - Mission and Clinical Competencies

Mission Statement
Homeopathy is an integral part of naturopathic medicine and a vital tool used by
naturopathic doctors in healing their patients. Bastyr University is committed to teaching
homeopathy with the highest standards in order to graduate naturopathic doctors who are
competent and skilled in the use of homeopathic medicines.


Clinical Competency - Homeopathy
(Optional—ONLY FOR HOMEOPATHY CLINICIANS)
Student Name:                                               Quarter/Year:

Supervisor/    Requirements
Initial/Date
               To register in the homeopathy shift as a secondary student clinician
               Complete Homeopathy III. Registration in Homeopathy IV is preferred.
               To become primary clinician
               Satisfactorily fulfill the responsibilities of a secondary clinician (as below) on 2
               shifts
               Complete and turn in written analysis on 2 cases
               Act as the primary clinician on one office call, which includes taking and
               analyzing the case, and keeping the patient’s chart up to date.
               Be available for case discussion with supervising doctor
               Demonstrate the ability to remain present and receptive to the patient
               Fulfill the responsibilities of a secondary clinician on 2 shifts
               Complete and turn in a written analysis of 2 cases that you have observed
               Act as a primary clinician on one office call that includes taking and analyzing
               the case and writing up the patient’s chart notes
               Be available for case discussion with the supervising doctor
               Responsibilities - Secondary Student Clinician
               Same as general Patient Care Shift
               Adequate attendance is required, as described in the Student Clinician Handbook
               Ensure that appropriate paperwork is available for signature, such as dispensary
               forms, consent forms, and treatment plans.
               Keep track of patient contacts
               Cooperate with the primary clinician and the supervising doctor
               Participate in the taking of the case – demonstrate active listening and appropriate
               questioning.
               Participate in case preview/review – come prepared to review by reading patient
               charts.


                                        Page 205
                Unique to Homeopathy Specialty Shift
                Write down the patient’s case with appropriate homeopathic underlining,
                observations, etc. on all patient visits.
                Study the case alone, or with a primary clinician, and be prepared to discuss and
                analyze the case with the supervising doctor in case preview/review.
                Demonstrate adequate knowledge and use of the repertory and materia medica as
                it applies to the patient symptoms.
                Homeopathic Grand Rounds: All homeopathic student clinicians are required to
                attend a minimum of five sessions of Grand Rounds in order to enhance their
                clinical case study and analysis experience in Homeopathy. Primary clinicians
                may be required to attend Homeopathic Grand Rounds, whenever they have a
                case that needs study and analysis beyond the homeopathic clinic office call
                procedure.
                All homeopathic clinicians should be able to demonstrate adequate knowledge
                and use of the repertory and materia medica as it applies to the patient’s
                symptoms.

ND CLINICAL COMPETENCY 10
Clinical Competency - Specialty
Homeopathy (Optional—ONLY FOR HOMEOPATHY CLINICIANS)
Student Name:                                               Quarter/Year:
Supervisor/    Competency
Initial/Date
               Primary Clinical Competencies for Student Homeopathic Clinicians
               Same as general Patient Care shift
               Assume responsibility for attendance, charting, and tracking the number of
               patient visits
               Keep track of patient contacts and ensure that you have seen an adequate
               number of patients.
               Cooperate with secondary clinician and supervising doctor
               Participate in case preview/review
               Adequately chart the patient’s visit in a timely fashion. (within 24 hours)

ND CLINICAL COMPETENCY 10
Clinical Competency - Specialty
Homeopathy
Student Name:                                                       Quarter/Year:

Supervisor      Goals and objectives - students in the Homeopathy specialty shift will gain
Initials/Date   experience, increase competence, and demonstrate skills in the following ways:
                Communication skills
                Explain homeopathy treatment to the patient in clear, and understandable terms.
                Instruct patients how to take the medicine appropriately and what to expect from
                their treatment

                                        Page 206
Discuss with the patient what we expect from them in terms of life-style habits,
making follow-up appointments, when they can phone the clinic, etc.
Display open, and cooperative communications with peers and with supervising
doctors.
All students will be held to the highest standards of professional and ethical
behavior. These include: patient confidentiality, personal responsibility,
impartiality, professional accountability and an appropriate understanding and
respect of ethical personal boundaries.
Case taking skills
Establish adequate rapport with patient
Demonstrate proper use of open ended and confirmatory questions, listening
skills and full homeopathic case taking plus review of systems, past medical
history, family medical history, etc.
Be able to take a full case in a reasonable amount of time
Demonstrate good charting skills, including underlining and completeness of
information, that is readable and relevant
Case assessment and analysis skills
Medical differential diagnosis
Proper lab and other testing in order to confirm the diagnosis
Proper physical examinations
Recognize acute vs. chronic prescribing
Identify the patient’s complaints from a homeopathic perspective. This includes
the chief complaint, the center of gravity, the etiology, the recognition of
general, particular, and mental/emotional symptoms; the differentiation of
strange, rare, and peculiar symptoms from common symptoms; identification of
the miasmatic basis of the patient’s disease, and an assessment of the strength of
the patient’s Vital Force.
Demonstrate an adequate knowledge and use of the repertory and materia medica
as it applies to the patient’s symptoms
Demonstrate the systematic thought processes of homeopathic assessments:
essence, keynote, totality, etiology, reliable symptoms, etc.
Demonstrate adequate knowledge of comparative materia medica, and
confirmatory and keynote symptoms, in order to arrive at the proper selection of
the medicine.
Give rationale for potency selection.
Give evaluation of prognosis of treatment.
Follow-up case skills
Show initiative and persistence in following up.
Take follow-up case appropriately and comprehensively.
Evaluate the action of the remedy within appropriate timelines.
Demonstrate the ability to effectively communicate with other medical
professionals, and to refer to them when appropriate, in order to ensure optimal
patient care.



                       Page 207
COUNSELING DEPARTMENT

Bastyr Center for Natural Health - Mission and Clinical Competencies

Mission Statement:
The mission of the Counseling Department is to train naturopathic medical students in
relationship-centered care and help students achieve personal integration.


ND CLINICAL COMPETENCIES - COUNSELING
Clinical Competency Five
Counseling

Student Name:                                              Quarter/Year:
DURING THE FIRST AND SUBSEQUENT SHIFTS THE STUDENT WILL MEET THE
FOLLOWING COMPETENCIES WHEN POSSIBLE:


Supervisor      Objective
Initial/Date
                Establish rapport, demonstrate counseling characteristics, (congruence,
                empathy, positive regard) and communication skills (paraphrasing, clarifying,
                reflecting, summarizing) in the counseling session.
                Engage his/her healer/physician within during the counseling session.
                Clinically assess patients Jungian Typology and use this assessment to inform
                the selection of counseling interventions
                Articulate the theoretical underpinnings of humanism as conveyed by Maslow,
                ay, Shostrum and Rogers.
                Recognize indicators of mood, anxiety, eating disorders, alcoholism, and
                somatization problems in patients and assess according to the DSM-IV.
                Establish a continuing relationship with patients beyond the first interview,
                carry a case load, chart, develop and follow a treatment plan.
                Recognize and maintain professional limitations and boundaries, creating a safe
                therapeutic environment for patient and physician.
                Assess, stabilize, treat and/or refer a suicidal patient.
                Demonstrate the ability to refer out to appropriate mental health providers and
                write a referral letter.
                Incorporate the Principles of Naturopathic Medicine into the counseling
                relationship, and case management (The Healing Power of Nature, First Do No
                Harm, Find the Cause, Treat the Whole Person, Preventative Medicine,
                Wellness and Doctor as Teacher).
                Demonstrate the ability to wait, understand and empathize prior to
                implementing an intervention, and if an intervention is necessary,
                to select one that is least invasive.

                                       Page 208
Supervisor       Objective
Initial/Date
                 Demonstrate the ability to separate symptoms from cause.

                 Recognize the person beyond the disease and support all aspects of the patient’s
                 life within the counseling relationship and treatment planning.
                 View the patient from an over-all perspective and assess what could help
                 prevent further disease and strengthen health. Demonstrate how mental health
                 and physical health are components of optimal health.
                 Demonstrate an ability to establish a wellness alliance, wellness consultation
                 and to stimulate wellness throughout the healing process.
                 Educate the patient concerning the healing process, their place in that process,
                 how to promote healing and to take responsibility for their own health.
                 Assess personal/professional limits and ask for help when needed.
                 Be able to assess oneself accurately in the doctor-patient relationship and be
                 able to assess ones influence on a patient’s experience.
                 Be able to maintain a patient caseload.
                 Demonstrate initiative in referring patients to other clinic departments as
                 appropriate.
                 Demonstrate understanding and acceptance of sexual preference and gender
                 orientation.
                 Demonstrate comfort and confidence when discussing sexual issues with
                 patients.




ADDICTIONS AND DISORDERS
In addition to the above competencies, students taking their first shift during the Fall of
the 3rd year in the 4th year track or the 4th year of the 5 year track, will meet the following
competencies when presented:
Supervisor         Competency
Initial/Date
                   Diagnose chemical dependency, assess the appropriate level of treatment and
                   develop a treatment plan which aligns with the principles and scope of the
                   naturopathic model.
                   Diagnose eating disorders, assess the appropriate level of treatment and develop
                   a treatment plan which aligns with the principles and scope of naturopathic
                   medicine.




                                        Page 209
PSYCHOLOGICAL ASSESSMENT
In addition to the above competencies, students taking their first shift during the Winter
quarter of the 3rd year in the 4 year track or 4th year of the 5 year track, will meet the
following competencies when presented:
Supervisor        Competency
Initial/Date
                  Recognize psychotic and characteristically disturbed patients, determine when
                  counseling would be effective, whether counseling in each case lies within
                  scope of naturopathic medicine, and make an appropriate psychological or
                  psychiatric referral.
                  Demonstrate ability to conduct an assessment interview and make an
                  appropriate diagnosis using the DSM IV.

DEATH AND DYING: COUNSELING THE TERMINALLY ILL AND THEIR
FAMILIES
Those students who are taking or who have taken “Death and Dying: Counseling the
Terminally Ill and Their Families” will also be responsible for the following
competencies when presented:
Supervisor       Competency
Initial/Date
                 Identify psychological issues, stages and tasks for patients and families facing
                 terminal illness.
                 Identify/ develop/ strengthen effective coping skills and styles for patients and
                 families to face death and survive loss.

SECOND COUNSELING SHIFT
Students taking a second counseling shift will have completed all six critical counseling
psychology courses. Students will meet the preceding competencies 1-17 to an even
greater extent and will meet the following competency:
Supervisor       Competency
Initial/Date
                 Present a case in a professional format.

SECOND COUNSELING SHIFT IN THE IMMUNE CLINIC
Students will have completed all six critical counseling psychology courses and will meet
the preceding competency plus the following competencies when presented:\
Supervisor       Competency
Initial/Date
                 Demonstrate an understanding of the psychological needs of HIV+ patients and
                 the ability to counsel them.
                 Co-facilitate a group addressing the specific psychological needs of patients
                 affected by HIV+.




                                        Page 210
ND CLINICAL COMPETENCIES
Clinical Competency Seven
Dispensary
Student Name:                                                Quarter/Year:


Clinical Competencies: Dispensary

Secondary student clinicians are required to complete product analyses using the
provided Product Analysis Sheet and submit them to the Product Review Coordinator
(PRC) with whom they will meet quarterly for review and check-offs. Students will
choose from the following list of conditions observed on patient care shifts and then
compare the treatments chosen to two other potential treatments. For example, if you
chose a vitamin supplement, compare that supplement to 2 other vitamin supplements for
the same condition. If a tea/tincture and a supplement, etc. are prescribed, you may
compare products in the two categories. You may only review treatments for a specific
condition once. Above each review table, write the chief complaint, relevant subjective
and objective findings, and assessment. Use the table below to record completion of
product reviews.
                         Supplement Tea or             Homeopathy/Bach Topical Tx/
                         Prescriptio Tincture          Flower                Suppositories/
                         n Substance                   Essences/Cell         Essential Oils
                                                       Salts
                         Required #    Required # of    Required # of        Required # of
                         of Product    Product          Product Analyses     Product
                         Analyses      Analyses                              Analyses
                         10            10               5                    5
                          Check         Check            Check                Check
                         PRC           PRC              PRC                  PRC

Anxiety
Arthritis
Asthma
Abnormal PAP
Cancer
Cholelithiasis
Constipation
Cough
Depression
Detox
Diabetes
Diarrhea
Dysbiosis
Eczema
Fibrocystic Breast
Headache/Migraine

                                        Page 211
HIV
Hyperlipidemia
Hypertension
Hypo/Hyperthyroidism
IBD
Insomnia
Menopause
Musculoskeletal
Sprain/Strain, Acute
Myalgia
Nutritional Deficiency
Osteoporosis
Otitis, Pediatric
Peptic Ulcer
Disease/Esophagitis
Pharyngitis
PMS/Dysmenorrhea
Sinusitis/URI, Acute
UTI
Vaginitis




                         Page 212
Product Analysis Sheet                                     Student

Name___________________________________________       Date_____________________

CC:      ____________________________________________________________________

Relevant subjective findings: __________________________________________________

Relevant objective findings: ___________________________________________________

Assessment(s):      ____________________________________________________________


                        Product            Comparison 1       Comparison 2
Supplements

a. Intended
mechanism of action.




b. How are the
actions/effects
beneficial to the
patient?




                                      Page 213
Product Analysis Sheet                                    Student

Name_________________________________________ Date        _____________________

CC:      ____________________________________________________________________

Relevant subjective findings: __________________________________________________

Relevant objective findings: ___________________________________________________

Assessment(s):      ___________________________________________________________

                       Product            Comparison 1       Comparison 2
Teas/Tinctures

a. Intended
mechanism of action.




b. How are the
actions/effects
beneficial to the
patient?




                                     Page 214
Product Analysis Sheet                                     Student

Name_________________________________________ Date         _____________________

CC:      ____________________________________________________________________

Relevant subjective findings: __________________________________________________

Relevant objective findings: ___________________________________________________

Assessment(s):      ____________________________________________________________


Homeopathics,
Bach Flowers,             Product           Comparison 1         Comparison 2
Cell Salts
a. Intended
mechanism of
action.




b. How are the
actions/effects
beneficial to the
patient?




c. Dose and
therapeutic
range.




                                      Page 215
Product Analysis Sheet                                     Student

Name_________________________________________ Date         _____________________

CC:      ____________________________________________________________________

Relevant subjective findings: __________________________________________________

Relevant objective findings: ___________________________________________________

Assessment(s):      ____________________________________________________________


                        Product            Comparison 1       Comparison 2

Topicals,
Suppositories,
Essential Oils

a. Intended
mechanism of action.




How are the
actions/effects
beneficial to the
patient?




                                      Page 216
Amended Appendices

Appendix #
1     Clinic Contract
2     AOM Program China Externship Application Form
3     Absences/Substitute Form – Student Clinician
4     Examples of Clinic Evaluation Forms
4a    Student Daily Shift Check-Off Evaluation Form – Patient Care
4b    Secondary Student Evaluation Form – Patient Care
4c    Primary Student Evaluation Form – ND Patient Care
4d    AOM Program Observation Evaluation
4e    AOM Program Internship Evaluation
4f    CHM Internship/Observation Evaluation Form
5     Examples of Student Clinic Evaluation Forms
5a    Secondary Clinician (Clinic Practicum I)
5b    Primary Clinician (Clinic Practicum II and III)
5c    Qualitative Student Clinician Video
5d    Student Preceptorship Plan
5e    Student’s Self-Evaluation
5f    Student Patient Contacts
5g    Student Evaluation of Preceptor
5g    Preceptor’s Evaluation of Student Experience and Documentation of Hours
App E Medical Abbreviations
7     Documentation Guidelines for Evaluation and Management Services
8     Co-Management: Templates and etiquette guidelines & referral letters
9     Naturopathic Treatment of Malignancy Consent Form




                                     Page 217
Appendix 1


CLINIC CONTRACT

By signing this document I am verifying that I have thoroughly read and familiarized
myself with the Student Clinician Handbook. I have especially noted the following areas
and made note of the differences in these areas between Academic Classroom Policy and
Procedures and Clinic Policy and Procedures.
CLINIC REGISTRATION PROCESS AND POLICIES
ADD/DROP PROCESS AND DEADLINE POLICIES
PAPERWORK DUE DATES
CLINICAL COMPETENCIES
PROFESSIONAL CONDUCT AND CODE OF ETHICS

I will adhere to all confidentiality procedures and policies, knowing that all patient
information is confidential and should never be removed from the clinic or discussed
outside of the clinic.
I understand and agree that I am responsible for knowing, understanding, and following
all the information contained within the Student Clinician Handbook, including all
revisions and updates. I understand that I will be held accountable for following and
adhering to these policies and procedures. I also agree and acknowledge that any
intentional falsification in my clinical competency, documentation of patient contact
hours and clinic time sheets is cause for denial of all related clinic hours and may lead to
additional disciplinary sanctions.


Signed ____________________________________                   Dated ______________

Printed name____________________________Degree Program(s)______________

GIVE SIGNED COPY TO CLINIC REGISTRATION STAFF FOR FILE BEFORE
ENTERING CLINIC.
PLEASE KEEP A COPY FOR YOUR RECORDS.




                                         Page 218
Appendix 2

AOM PROGRAM CHINA EXTERNSHIP APPLICATION FORM

Name: _________________________________
Address: _______________________________

Phone:

Emergency Contact While in China

Phone: _________________________________

E-MAIL        ___________________________

DESIRED QUARTER FOR CHINA EXTERNSHIP:
_____________________________________________________________________
Please supply the following information:
Copy of latest Clinic Requirement Summary sheet from Clinic registration staff.
Number of credits you expect to take in China
Passport number and date of expiration
A short description of the experience you are hoping for and why you want to go.
How do you plan to pay for this experience?




                                    Page 219
Appendix 3

BASTYR CENTER FOR NATURAL HEALTH
ABSENCE/SUBSTITUTE FORM - STUDENT CLINICIAN
It is the responsibility of every student clinician to inform both their assigned supervising
Clinical Faculty and the Clinic Program Coordinator (CAC) of any absence from clinic.
Please follow the procedures outlined below:
Fill out the bottom portion of this form. (Fill out a separate form for each shift you will
be absent.)
Notify your supervising doctor/Clinical Faculty of each shift you will miss, and have
him/her sign the appropriate space below.
Turn this form in to the Clinic Program Coordinator – at the BCNH, for approval.
Primary student clinicians must get a substitute.
Secondary student clinicians must get a substitute.
Please do all of this in advance of the shift(s) you will be absent, preferably at least one
week prior to your absence. (If you are ill or have an emergency situation, call in to the
Clinical Faculty/CAC/CMD or leave message on phone machine.)
The Clinical Faculty/CAC/CMD will notify the front desk staff, who in turn will make
the changes in the schedule book. Students should not write in or make changes in the
schedule book.
An unexcused absence will result in an automatic failure for the quarter.
NAME OF STUDENT: __________________ ID#:________________
TODAY’S DATE:___________ DATE OF EXPECTED ABSENCE____
SHIFT: (circle one) morning          afternoon     evening
Circle Appropriate Modality:
Naturopathic General Patient Care              Homeopathy Physical                  Nutrition
                                                               Medicine
Acupuncture/Oriental Medicine/CHM              Counseling      Lab
Reason for Absence_________________________________________________
Name of Student Substitute __________________________________________
Supervising Doctor/Clinical Faculty SIGNATURE
_________________________________
Confirmation of Substitute SIGNATURE
_________________________________________
Clinic Program Coordinator___________________ Date________________
Assistant Patient Services Manager _____________ Date________________




                                         Page 220
Appendix 4a
BASTYR CENTER FOR NATURAL HEALTH
STUDENT DAILY SHIFT CHECK-OFF EVALUATION FORM - PATIENT
CARE
STUDENT NAME: _______________________________________
DATE______________
QUARTER/YEAR: _________________________
SHIFT____________________________
NUMBER OF PATIENTS SEEN ON
SHIFT______________________________________
RATING SCALE:
NA = not applicable
         1 = unsatisfactory (F)
         2 = adequate (AC)
         3 = good (AC)
         4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Supervisor        Objective
Initial/Date

            Clinical Skills
            Initiative, motivation, responsibility
            Communications skills and rapport with patients
            Interview skills (S)
            Physical exam (O)
            Differential diagnosis/assessment skills (A)
            Knowledge of naturopathic therapeutics and their proper application
            Patient case preparation and follow up
            Familiarity with clinic policies and procedures and efficiency in following them
            Listening skills
            Time management skills
            Proper use of lab, diagnostic studies, etc.
            Ability to make an appropriate referral when needed and ability to write up
            referral
            Charting technique (completeness and clarity)
            Participation and input in case discussions on shift, case preview and case review
Summary comments: This space for comments/suggestions/recommendations and/or to
explain and

                                          Page 221
Clarify ratings above: Supervising Clinical Faculty must sign & date
Appendix 4b

BASTYR CENTER FOR NATURAL HEALTH
SECONDARY STUDENT EVALUATION FORM - PATIENT CARE
STUDENT NAME: _______________________________________
QUARTER/YEAR:                                     SHIFTS:
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate        (AC)
3 = good            (AC)
4 = excellent       (AC)

An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.

CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.
*1.     Initiative and responsibility in role as a secondary student clinician:
*2.     Cooperation with clinic supervisors and staff:
*3.     Familiarity with clinic policies and procedures and efficiency in following them:
*4.     Physical exam skills:
*5.     Application of academic learning to clinic training:
*6.     General overview of case management:
*7.     Listening skills:
  8.   Communication skills and rapport with peers and supervisors:
  9.   Time management skills:
 10.    Motivation and initiative in learning clinical skills:
 11.    Participation and input in case discussions on shift:
Student’s overall level based on the number of quarters in the clinic: (there are 8 total
quarters):
(please circle the one that is most appropriate)
1       2        3       4       5       6       7    8
Summary Comments: (please write comments to explain and/or clarify your ratings above.

Please Indicate Grade For This Quarter: (circle one)
Failure (F)     In-Progress (IP)      Partial Competency (PC)                Achieved Competency
(AC)

Supervisor’s Signature                                       Date ___________

                                             Page 222
Appendix 4c
BASTYR CENTER FOR NATURAL HEALTH
PRIMARY STUDENT EVALUATION FORM - ND PATIENT CARE
STUDENT NAME___________________________________________________________
QUARTER/YEAR:
      SHIFTS_________
Approximate number of patient visits you supervised this student this quarter:   ___
RATING SCALE: ____
NA = not applicable
1 = unsatisfactory (F)
2 = adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.
* Initiative and responsibility in patient care:
* Communication skills and rapport with patients:
* Interviewing skills:
* Physical exam skills:
* Overall case management skills:
  Charting technique (completeness and clarity):
  Application of academic learning to clinic training and patient care:
  Differential diagnosis/assessment skills:
  Knowledge of Naturopathic therapeutics and their proper application:
* Patient follow-up care:
  Listening skills:
  Time management skills:
  Cooperation with clinic supervisors and staff:
  Communication skills with peers and supervising doctors:
  Motivation and initiative in learning clinical skills:
  Familiarity with clinic policies and procedures and efficiency in following them:

Student’s overall level is based on the number of quarters in the clinic: (there are 8 total
quarters):
(please circle the one that is most appropriate)
1        2        3        4        5        6       7       8
Summary Comments: (please write comments to explain and/or clarify your ratings above)
Please Indicate Grade For This Quarter: (circle one)
failure (F)       in-progress (IP)        partial competency (PC)     achieved competency (AC)

Supervisor’s Signature                                                  Date ____________________



                                                Page 223
Appendix 4d
Bastyr CENTER FOR natural health
AOM PROGRAM OBSERVATION EVALUATION
STUDENT NAME:
QUARTER/YEAR: SHIFTS:
The number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate              (AC)
3 = good                  (AC)
4 = excellent             (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Rate each of the following categories and give an overview rating at the end.
Initiative and responsibility in role as Observation Clinician: _______
Cooperation with clinic supervisors and staff: _______
Communication skills with peers and supervisors:            _______
Familiarity with Clinic Policies and procedures and efficiency in following them:_______
Interviewing skills: _______
Time Management Skills:           _______
Charting technique (completeness and clarity): _______
OM Inspection skill and interpretation of tongue diagnosis: _______
OM Auscultation and Olfaction skill: _______
OM Palpation skill and interpretation of pulse diagnosis: _______
Application of academic learning to clinic training: _______
Eight Principles diagnosis skill: _______
Zang-Fu Patterns diagnosis and differention skills:         _______
General overview of case management:               _______
Motivation and initiative in learning clinical skills:      _______
Overall Rating of Clinic Work and Performance for this Quarter:             _______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student
must demonstrate competency ( a 2 or more) on all skills above as well as the overall rating
relative to their current level in the clinic. Please refer to the appropriate clinic competencies
for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)       In Progress (IP) Partial Competency (PC) Achieved Competency (AC)

Supervisors
Signature____________________________________Date_____________________

                                           Page 224
Appendix 4e

BASTYR CENTER FOR NATURAL HEALTH
AOM PROGRAM INTERNSHIP EVALUATION
STUDENT NAME:
QUARTER/YEAR:           SHIFTS:
Approximate number of patient visits you supervised this student this quarter:

RATING SCALE:
NA = not applicable
1 = unsatisfactory            (F)
2 = adequate        (AC)
3 = good                      (AC)
4 = excellent                 (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in
all the clinical categories appropriate to her/his status in clinic. A PC grade is given if all critical clinical
skills are successfully demonstrated and one non-critical skill is assessed as unsatisfactory (1 on scale at
left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more
non-critical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an AC must accompany
the grade. See the Clinic Handbook and grading manual for details.
Rate each of the following categories and give an overview rating at the end.
*Initiative and responsibility in role as Intern Clinician: _______
2.         Cooperation with clinic supervisors and staff:            _______
3.         Communication skills with peers and supervisors:          _______
4.         *Communication skills and rapport with patients:          _______
5.         *Interviewing skills:       _______
6.         Time Management Skills: _______
7.         Charting technique (completeness and clarity):            _______
8.         *OM Four Exams skills: _______
9.         *OM Eight Principles Skills:          _______
10.        *Application of acupuncture points location: ___________
11.        Accuracy of acupuncture points location:        _______
12.        Needling techniques:        _______
13.        Moxibustion techniques: _______
14.        Cupping and other techniques:         _______
15.        Clean needle technique: _______
16.        Knowledge of Oriental Medicine therapeutics and their proper application:________
17.        *Patient follow-up care: ________
18.        Familiarity with clinic policies and procedures and efficiency in following them: _______
19.        Appropriate application of Western assessment techniques: ________
20.        Appropriate referral or consideration for referral: ______

Overall Rating of Clinic Work and Performance for this Quarter:            _______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student must demonstrate
competency ( a 2 or more) on all skills above as well as the overall rating relative to their current level in the
clinic. Please refer to the appropriate clinic competencies for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)        In Progress (IP) Partial Competency (PC) Achieved Competency (AC)


_________________________               ________________
Supervisor’s Signature                Date



                                                  Page 225
Appendix 4f

BASTYR CENTER FOR NATURAL HEALTH
CHM INTERNSHIP/OBSERVATION EVALUATION FORM

STUDENT NAME:

QUARTER/YEAR:                                                             SHIFTS:

RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate             (AC)
3 = good                 (AC)
4 = excellent            (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.

Rate each of the following categories, and then give an overall rating.
1. *Interest and responsibility in patient care: __________
2. *Cooperation with clinic supervisors and other clinicians: _________
3. Communication skills with peers and supervisors: __________
4. *Communication skill and rapport with patient: __________
5. *Interviewing skills: __________
6. *Diagnostic skills and case management: __________
7. Charting technique (completeness, clarify and signature): __________
8. Time management skills: __________
9. *Familiarity with Chinese herbs and basic formulas: __________
10. Knowledge of Chinese Herbal Medicine therapeutics and their proper application:
__________
11. *Written clarity of prescriptions and any necessary instructions for packaging herbs:
__________
12. Clear explanation of cooking instructions: __________
 *Follow up care with patients: __________


Summary Comments: (please write comments to explain and/or clarify your ratings above.)
Please indicate grade for this Quarter (circle one)
Failure (F)        In Progress (IP)             Partial competency (PC)   Achieved Competency (AC)

___________________________                              _____________________

Supervisor’s signature                                       Date

                                                 Page 226
Appendix 5A

Nutrition Clinic Evaluation Form
Secondary Clinician (Clinic Practicum I)
Bastyr Center for Natural Health

Student Name             Signature

Nutrition Supervisor Name               Signature

Evaluation Date                         Quarter

Rating Scale:

NA = Not applicable
1 = Unsatisfactory (F)
2 = Adequate (AC)
3 = Good (AC)
4 = Excellent (AC)

An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one non-
critical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one
or more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.

CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.

1. Familiarity with Clinic Operations

                Read Student Clinician Handbook
                Able to retrieve medical charts
                Familiar with clinic forms, nutrition handouts, teaching aids and reference
                manual/books.
                Comments:

2. Participates with the Care Team*

                Actively participates in preview and review every clinic shift
                Assists the primary student clinician with interviewing and providing
                nutrition education
                Comments:

                                          Page 227
3. Data Collection*

              Reviews the medical record for pertinent patient data
              Assists the primary student clinician with presenting the patient case
              during preview
              Accurately obtains the weight, height, and wrist circumference
               of the patient
              Comments:

4. Interview and Education*

______        Develops rapport with the patient
______        Communicates appropriately with patients, students, supervisors, and
              other staff
______        Assists the primary student clinician with obtaining information from the
              patient and providing education that is individualized and within the
              overall treatment plan for the patient
______        Assists the primary student clinician in developing an individualized
              nutrition care plan based on medical record and interview information

              Comments:


5. Documentation*

              Completes team recommendation form and reviews it with the patient
              Completes the Super Bill
              Correctly perform calculations necessary for the SOAP note
              Completes a minimum of 5 practice SOAP notes during the quarter
              Comments:

6. Professionalism*

              Observes the policies and procedures of the facility
              Punctuality and attendance
              Reliability
              Professional appearance
              Demonstrates respect and dignity to others
              Willing to work as a team player
              Accepts constructive criticism
              Demonstrates initiative
              Assignments completed as scheduled
              Demonstrates positive work relationships and attitude
              Comments:


                                       Page 228
7.    Organization and Time Management*

____Efficient use of time
____Integrates unexpected duties into the work schedule
____Completes working an orderly manner
____Comments


______Overall Evaluation

AC = Achieved Competency (meets or exceeds skill level).
F = Failed (does not meet minimal skill level, student will need to repeat Clinic
Practicum).
IP = In Progress (all work requirements of the Clinic Practicum have not been met by the
end of the quarter).
PC = Partial competency (an aspect of the learning objectives or core competencies have
not been achieved and there is need for further study to earn the required AC).

In your opinion, what are the student’s major strengths and weaknesses?


If the student has received a rating of 1, please specify what is needed to improve and
suggestions as to learning activities that may be used to improve performance.



Additional Comments:


Supervisor Signature____________________               Date_____________________




                                        Page 229
Appendix 5b
Nutrition Clinic Mid-Quarter Evaluation Form
Primary Clinician (Clinic Practicum II and III)
Bastyr Center for Natural Health


Student Name __________                      Signature

Nutrition Supervisor Name ____               Signature

Evaluation Date              Quarter

Directions:
Students: Complete a self-critique of your counseling skills and review with your
supervisor.
Supervisors: Complete the evaluation and review with the student.

NA = Not applicable
1 = Unsatisfactory (F)
2 = Adequate (AC)
3 = Good (AC)
4 = Excellent (AC)

1. Nutrition Knowledge

              Ability to make specific diet recommendations
              Appropriate recommendations for vitamin/mineral supplementation
Comments:




2. Interviewing Skills

              Organized approach
              Controls interview direction
              Effectively probes problem areas in patient’s diet/lifestyle
Comments:




                                       Page 230
3. Assessment Skills

                Establishes rapport with patients
                Appropriately prioritizes patient’s nutrition concerns
                Sets goals and desired outcomes in coordination with the patient
                Selects appropriate education materials
                Provides culturally/economically appropriate diet recommendations
                Maintains control of session
                Closes session by summarizing goals, action plans, and answering final
questions for the patient.
Comments:




4. Documentation

              Concisely and accurately documents counseling session in SOAP note.
Comments:




5. Time Management

              Efficient use of time
Comments:




In your opinion, what are the student’s major strengths and weaknesses?




What areas of development does the student need to strengthen during the remainder of
the quarter?


__________________________                          ______________
Supervisor Signature                                    Date


                                       Page 231
Appendix 5c
Bastyr Center for Natural Health
Nutrition Program
Qualitative Student Clinician Video
Evaluation Form

Circle the number that most closely describes the level of skill:
Skill Low High

A.      Communication
Tone of voice                         1       2        3     4      5     6      7
Clarity                               1       2       3      4      5     6      7
Listening                             1       2       3      4      5     6      7
Rapport                               1       2       3      4      5     6      7
Non-verbal/body language              1       2       3      4      5     6      7
Note taking does not
interrupt communication flow1         2       3       4      5      6     7

B.      Interviewing
Opening
Establish rapport w/patient            1      2       3      4      5     6       7
Transition to session purpose          1      2       3      4      5     6       7
Identifies session purpose             1      2       3      4      5     6       7
Questioning
Gather appropriate information
in a logical sequence                  1      2       3      4      5     6       7
Uses open or closed question
appropriately                          1      2       3      4      5     6       7
Uses primary and secondary
questions appropriately                1      2       3      4      5     6       7
Uses leading or neutral
questions appropriately                1      2       3      4      5     6       7
Clinician’s response to the patient information (circle the most common response):
Evaluation      Probing        Hostile Understanding Reassuring     Confrontational

Closing
Shows appreciation                    1       2       3      4      5     6      7
Next steps in appointment             1       2       3      4      5     6      7
Recap of information given            1       2       3      4      5     6      7
Asks if any questions                 1       2       3      4      5     6      7
Comments:




                                          Page 232
C.      Nutrition Counseling
Awareness – both parties aware of problems, patterns, behaviors
misinformation, and health hx       1      2       3      4       5       6      7
Involves pt in identifying goals    1      2       3      4       5       6      7
Prioritized goals w/pt help         1      2       3      4       5       6      7
Identifies potential barriers       1      2       3      4       5       6      7
Discusses appropriate steps to
achieving goals                     1      2       3      4       5       6      7
Information individualized to pt    1      2       3      4       5       6      7
Pt. able to summarize information 1        2       3      4       5       6      7
Discussion of next steps to take    1      2       3      4       5       6      7
Comments:

D.      Overall Evaluation
AC = Achieved Competency (meets or exceeds skill level).
F = Failed (does not meet minimal skill level, student will need to repeat Clinic
Practicum).
IP = In Progress (all work requirements of the Clinic Practicum have not been met by the
end of the quarter).
PC = Partial competency (an aspect of the learning objectives or core competencies have
not been achieved and there is need for further study to earn the required AC).
_________________________                             ___________________
Supervisor signature                                 date




                                       Page 233
Appendix 5d
Bastyr University Naturopathic Medicine Preceptorship Program

Student Preceptorship Plan

(To be completed and turned in to Placement Coordinator PRIOR to preceptoring.)


Student (please print):
_______________________________________________________________

Student Area Code/Telephone Number: __________.__________._______________

Expected Graduation (Quarter/Year): ______________________ Class Level (ex. 2nd/4th):
__________




Preceptor’s Name (please print): _________________________________Title: (ND, MD, etc.)
______

Preceptor’s Area Code/Telephone Number: __________.__________.______________

Site Name:
______________________________________________________________________

Address:
_______________________________________________________________________


_______________________________________________________________________


_______________________________________________________________________


Learning Objectives: Please list two to three objectives you wish to accomplish in working
with this preceptor at your chosen site.

Student Signature: _______________________________________________Date:
___________

Placement Coordinator Signature: __________________________________Date:
___________




                                            Page 234
Appendix 5e
Bastyr University Naturopathic Medicine Preceptorship Program

Student’s Self-Evaluation

Student (please print):
____________________________________________________________

Dates of Preceptorship: From: _______________________ To:
_________________________


       Self-Evaluation/Progress Scale:
Excellent, remarkable progress
Above average, substantial progress
Average, some progress
Below average, very little progress
Poor, no progress
N/A Not applicable

A.    Listening skills                   5         4      3       2        1       N/A
B.    Interviewing technique             5         4      3       2        1       N/A
C.    Physical exam technique            5         4      3       2        1       N/A
D.    Patient rapport/interaction        5         4      3       2        1       N/A
E.    Rapport with Preceptor             5         4      3       2        1       N/A
F.    Diagnostic skills                  5         4      3       2        1       N/A
G.    Case presentation                  5         4      3       2        1       N/A
H.    Time management                    5         4      3       2        1       N/A
 I.    Business administration skills    5         4      3       2        1       N/A
J.    Philosophy of healing              5         4      3       2        1       N/A
K.    Professional image                 5         4      3       2        1       N/A
L.    Other: (specify) _______________   5         4      3       2        1       N/A


In what ways did this experience meet your Learning Objectives? Were there ways in which
your preceptoring experience did not meet your Learning Objectives?

-Student ‘s Evaluation of Preceptor on reverse -

Bastyr University Naturopathic Medicine Preceptorship Program
Student’s Clinical Time Sheet

Student (please print): _____________________________________________________Date: ______________

Preceptor: ________________________________________________________________Title:
____________
Placement Coordinator’s Signature: _______________________________________________Date: -
_________________




                                             Page 235
Page 236
Appendix 5f

Student’s Patient Contacts ~ Documentation of ALL Patient Contacts required for credit.
(Referencing patient initials is for your documentation only – you do not ask patient to initial form.)
                                                        Student Name:
                                                                             FF




Date    Patient    Patient’s Chief Complaint       Medical Assessment        Follow-up and Future         Precep-
        Initials                                                             Plan for Patient             tor’s
                                                                                                          Initials




                                                       Page 237
Appendix 5g
ND Student’s Evaluation of Preceptor
Student Evaluation of Preceptor
(Confidentiality may be maintained by completing this form after preceptor signs off on
your evaluation.)

Preceptor’s Name (please print): _____________________________________________Title:
________

Preceptor’s Specialty:
_____________________________________________________________

Preceptor Evaluation Scale:
Excellent
Above average
Average
2. Below Average
Poor
N/A Not applicable

A.   Mentoring style                            5         4        3       2       1        N/A
B.   Informative/ability to explain procedures  5         4        3       2       1        N/A
C.   Patient rapport/support                    5         4        3       2       1        N/A
D.   Clinical skills                            5         4        3       2       1        N/A
E.   Time management                            5         4        3       2       1        N/A
F.   Receptivity to new ideas                   5         4        3       2       1        N/A
G.   Integration of ND philosophy into practice 5         4        3       2       1        N/A
H.   Use of physical modalities                 5         4        3       2       1        N/A
I.   Other: (specify) _____________________ 5             4        3       2       1        N/A

Student’s response to preceptor’s teaching style; types of patients seen in practice; modalities
used, etc.



Would you recommend this preceptor to other students? Why or why not?



Student Signature: ____________________________________________ Date: _________

Placement Coordinator Signature: ________________________________ Date: _________




                                            Page 238
Appendix 5H
Bastyr University Naturopathic Medicine Preceptorship Program

Preceptor’s Evaluation of Student Experience and Documentation of Hours
(To be completed and signed by Preceptor)



Student’s Name (please print):
_______________________________________________________

Type of Experience:         ______Observational   ______Limited hands-on   ______Hands-on

Dates of Preceptorship: From: ______________________ To: ______________________



    Student Progress Evaluation Scale:
Excellent, remarkable progress
Above average, substantial progress
Average, some progress
Below average, very little progress
Poor, no progress
           N/A Not Applicable

Basic Skill Presentation
A. Professional appearance                        5     4      3      2      1     N/A
B. Ability to communicate with patients           5     4      3      2      1     N/A
C. Communication with staff                       5     4      3      2      1     N/A
D. Communication with practitioner                5     4      3      2      1     N/A
E. Basic diagnostic skills                        5     4      3      2      1     N/A
F. Basic therapeutic skills                       5     4      3      2      1     N/A

     Specific Skills Presentation
A.    Interviewing/health history                 5     4      3      2      1     N/A
B.    Physical exam                               5     4      3      2      1     N/A
C.    Pelvic/breast exam                          5     4      3      2      1     N/A
D.    Lab work-up/interpretation                  5     4      3      2      1     N/A
E.    Hydrotherapy treatment                      5     4      3      2      1     N/A
F.    Manipulation                                5     4      3      2      1     N/A
G.    Physical modalities                         5     4      3      2      1     N/A
H.    Differential diagnosis ability              5     4      3      2      1     N/A
I.    Application of theories                     5     4      3      2      1     N/A
J.    Public health education                     5     4      3      2      1     N/A

   Specialty in therapeutic area/practice is:
___________________________________________
A. General knowledge/understanding            5 4              3      2      1     N/A
B. Application of specialty knowledge         5 4              3      2      1     N/A
C. Integration of naturopathic medicine       5 4              3      2      1     N/A


                                            Page 239
Preceptor (please print): _______________________________________Title (ND, MD, etc.):
_______

Site Name:
_______________________________________________________________________

Address:
________________________________________________________________________


________________________________________________________________________

  ________________________________________________________________________

Preceptor comments and/or recommendations for student:


Thank you for serving as a preceptor and for completing this evaluation! Please return
this form to the student or, if you prefer, mail to:

Jeanne Kinley Deller, Placement Coordinator
Office of Graduate and Community Medicine, Bastyr Center for Natural Health
1307 North 45th Street, Seattle, Washington, 98103, USA
Telephone: 206.834.4103
Email: jdeller@bastyr.edu




TOTAL PRECEPTORING HOURS: _________              TOTAL PATIENT CONTACTS: ________




Preceptor Signature: ____________________________________________ Date:

Student Signature: ______________________________________________ Date:

Placement Coordinator Signature: _________________________________ Date:




                                        Page 240
Abbreviations
The use of medical and scientific abbreviations is time saving and often a standard practice in the healthcare industry. A
number of the abbreviations may appear with or without periods and with either capital or small letters.

Abbreviation        Meaning
AAMA                American Association of Medical Assistants
AB, ab              abortion
ABC                 aspiration biopsy cytology
ABG                 arterial blood gas
ac                  before meals (ante cibum)
AC                  air conduction
Acc                 accommodation
ACG                 angiocardiography
ACS                 American Cancer Society
ACTH                adrenocorticotropic hormone
AD                  right ear (auris dextra)
ad lib              as desired
adeno-CA            adenocarcinoma
ADH                 antidiuretic hormone
AE                  above the elbow
AFB                 acid-fast bacillus
AFP                 alpha-fetoprotein
AIDS                acquired immunodeficiency syndrome
AK                  above the knee
AKA                 above-knee amputation
ALL                 acute lymphocytic leukemia
AMA                 American Medical Association
AMI                 acute myocardial infarction
ANS                 autonomic nervous system
AP                  anteroposterior
AandP               auscultation and percussion
ARDS                adult respiratory distress syndrome
ARMD                age-related macular degeneration
AS                  aortic stenosis; left ear (auris sinistra)
ASD                 atrial septal defect
ASHD                arteriosclerotic heart disease
Astigm              astigmatism
ATN                 acute tubular necrosis
AV                  atrioventricular, arteriovenous
AVR                 aortic valve replacement
BaE                 barium enema
baso                basophil
BBB                 bundle-branch block
BE                  below the elbow
bid                 twice a day
BIN, bin            twice a night
BK                  below the knee
BKA                 below-knee amputation
BM                  bowel movement
BMR                 basal metabolic rate
BNO                 bladder neck obstruction
BP                  blood pressure
BPH                 benign prostatic hyperplasia; benign prostatic hypertrophy




                                                      Page 241
        Abbreviation        Meaning
        BUN              blood urea nitrogen
        bx               biopsy
        C1, C2 to C8     first cervical vertebra, second cervical vertebra through eighth cervical vertebra
        CA, Ca           cancer, calcium
        CAD              coronary artery disease
        CAT, CT computerized axial tomography
        CBC              complete blood count
        cc               cardiac catheterization; chief complaint
        cc               cubic centimeter
        CCU              coronary care unit
        CDC              Centers for Disease Control
        CDH              congenital dislocation of the hip
        CEA              carcinoembryonic antigen
        CHD              coronary heart disease
        CHF              congestive heart failure
        CI               chlorine
        cm               centimeter
        CMA              certified medical assistant
        CMML             chronic myelomonocytic leukemia
        CNS              central nervous system
        CO2              carbon dioxide
        COLD             chronic obstructive lung disease
        COPD             chronic obstructive pulmonary disease
        CP               cerebral pales
        CPD              cephalopelvic disproportion
        CPR              cardiopulmonary resuscitation
        CS, C-section    cesarean section
        CSF              cerebrospinal fluid
        CT               computed tomography
        CTS              carpal tunnel syndrome
        CV               cardiovascular
        CVA              cerebrovascular accident
        CVD              cardiovascular disease
        CWP              childbirth without pain
        CXR              chest x-ray
        cysto            cystoscopy
        D                diopter (lens strength)
        do               discontinue
        /d               per day
        DandC            dilation and curettage
        DDS              Doctor of Dental Surgery
        DandE            dilation and evacuation
        Derm             dermatology
        DI               diabetes insipidus; diagnostic imaging
        diff             differential count (white blood cells)
        DM               diabetes mellitus
        DO               doctor of osteopathy
        DOA              dead on arrival
        DOB              date of birth
        DPT              diphtheria, pertussis, tetanus
        DRGs             diagnostic related groups
        DUB              dysfunctional uterine bleeding
        DVT              deep vein thrombosis
        dx               diagnosis
        EBV              Epstein-Barr virus
        ECG, EKG         electrocardiogram
        ECF              extracellular fluid; extended care facility
        EDC              estimated or expected date of confinement
        EEG              electroencephalogram
        EENT             eye, ear, nose, and throat

Abbreviation      Meaning


                                                   Page 242
EMG               electromyogram
ENT               ear, nose, and throat
EOM               extraocular movement
eosin             eosinophil
ESR               erythrocyte sedimentation rate
EST               electric shock therapy
ET                esotropia
F                 Fahrenheit
FACP              Fellow, American College of Physicians
FAGS              Fellow, American College of Surgeons
FBS               fasting blood sugar
FDA               Food and Drug Administration
FEF               forced expiratory flow
FEKG              fetal electrocardiogram
FEV               forced expiratory volume
FH                family history
FHR               fetal heart rate
FHT               fetal heart tone
FS                frozen section
FSH               follicle-stimulating hormone
FTND              full-term normal delivery
FUO               fever of undetermined origin
FVC               forced vital capacity
Fx                fracture
GB                gallbladder
GC                gonorrhea
GH                growth hormone
GI                gastrointestinal
gm                gram
gr                grain
GTT               glucose tolerance test
gtt               drops (guttae)
GU                genitourinary
Gyn               gynecology
H                 hypodermic; hydrogen
h                 hour
HCG               human chronic gonadotropin
HCI               hydrochloric acid
HCO               bicarbonate
HCT, hot hematocrit
HD                hip disarticulation; hemodialysis; hearing distance; Hodgkin's disease
HDL               high-density lipoprotein
HEENT             head, eyes, ears, nose, and throat
Hg                mercury
Hgb, Hb           hemoglobin
HIV               human immunodeficiency virus
HMD               hyaline membrane disease
HNP               herniated nucleus pulposus (herniated disk)
HP                hemipelvectomy
hs                at bedtime
HSG               hysterosalpingography
HSV               herpes simplex virus
hypo              hypodermically
IAS               interatrial septum
IBD               inflammatory bowel disease
ICF               intracellular fluid
ICSH              interstitial cell-stimulating hormone
ICU               intensive care unit



         Abbreviation        Meaning
         IandD               incision and drainage


                                                     Page 243
        ID                 intradermal
        IDDM               insulin-dependent diabetes mellitus
        Ig                 immunoglobulin
        IH                 infectious hepatitis
        IM                 intramuscular
        inj                injection
        IOL                intraocular lens
        iop                intraocular pressure
        IPPB               intermittent positive-pressure breathing
        IQ                 intelligence quotient
        IRDS               infant respiratory distress syndrome
        IS                 intercostal space
        IUD                intrauterine device
        IV                 intravenous
        IVC                inferior vena cava, intravenous cholangiography
        IVF                in vitro fertilization
        IVP                intravenous pyelogram
        IVS                interventricular septum
        K                  potassium
        KD                 knee disarticulation
        kg                 kilogram
        KS                 Kaposi's sarcoma
        KUB                kidney ureter bladder
        l                  liter
        L1, L2 to L5       first lumbar vertebra, second lumbar vertebra through fifth lumbar vertebra
        LA                 left atrium
        LandA              light and accommodation
        LAT, lat           lateral
        LB                 large bowel
        LDL                low-density lipoprotein
        LE                 lupus erythematosus, lower extremity
        LH                 luteinizing hormone
        LLQ                left lower quadrant
        LMP                last menstrual period
        LP                 lumbar puncture
        LPN                Licensed Practical Nurse
        LRQ                lower right quadrant
        LUQ                lower upper quadrant
        LV                 left ventricle
        lymphs             lymphocytes
        MCH                mean corpuscular hemoglobin
        MCHC               mean corpuscular hemoglobin concentration
        MCV                mean corpuscular volume
        MD                 Medical Doctor
        mets               metastases
        mg                 milligram (1/1000 gram)
        MH                 marital history
        MI                 myocardial infarction; mitral insufficiency
        mix. astig         mixed astigmatism
        ml                 milliliter (1/1000 liter)
        mm                 millimeter (1/1000 meter; 0.039 inch)
        mono               monocyte
        MRI                magnetic resonance imaging
        MS                 mitral stenosis; multiple sclerosis
        MSH                melanocyte-stimulating hormone
        MVP                mitral valve prolapse
        Myop               myopia
        Na                 sodium


Abbreviation     Meaning
NPH              neutral prolamine Hagedorn (insulin)
NPO              nothing by mouth (nulla per os)

                                                  Page 244
NSAID         nonsteroidal anti-inflammatory drug
O2            oxygen
OA            osteoarthritis
OB            obstetrics
OB-GYN        obstetrics and gynecology
OCPs          oral contraceptive pills
OD            right eye (oculus dexter); overdose
od            once a day
OHS           open heart surgery
OR            operating room
Ortho, ORTH   orthopedics
OS            left eye (oculus sinister)
os            mouth; opening; bone
Oto           otology
OU            both eyes (oculi unitas)
OV            office visit
oz            ounce
P             pulse
PA            posteroanterior
Pap smear     Papanicolaou's smear
paren         parenterally
PAT           paroxysmal atrial tachycardia
Path          pathology
PBI           protein-bound iodine
PC            after meals
PCP           Pneumocystis carinii pneumonia
PCV           packed cell volume (hematocrit)
PD            peritoneal dialysis
PE            physical examination
PEI'          positron emission tomography
PGH           pituitary growth hormone
pH            hydrogen ion concentration
PID           pelvic inflammatory disease
PKU           phenylketonuria
PMN           polymorphonuclear neutrophil
PMP           previous menstrual period
PND           paroxysmal nocturnal dyspnea
PNS           peripheral nervous system
PO            orally
poly          polymorphonuclear neutrophil
pp            postprandial (after meals)
prn           as required
PT            prothrombin time; Physical Therapy
PTH           parathyroid hormone
PTT           partial thromboplastin time
PVC           premature ventricular contraction
q             every
qam           every morning
qd            every day (quaque die)
qh            every hour
q2h           every two hours
qid           four times a day
qpm           every night
qns           quantity not sufficient
R, rt         right
RA            right atrium, rheumatoid arthritis




                                              Page 245
        Abbreviation        Meaning
        rad                 radiation absorbed dose
        RAI                 radioactive iodine
        RBC                 red blood cell; red blood count
        RD                  respiratory tease
        REM                 rapid eye movement
        RLQ                 right lower quadrant
        R.N.                registered nurse
        RNA                 ribonucleic acid
        R/O                 rule out
        ROM                 range of motion
        RP                  retrograde pyelogram
        RU                  routine urinalysis
        RUQ                 right upper quadrant
        RV                  right ventricle
        Rx                  prescription, treatment, therapy
        s                   without
        SI, S2 to SS        first sacral vertebra, second sacral vertebra through fifth sacral vertebra
        SA                  sinoatrial node
        SC                  subcutaneous
        SCD                 sudden cardiac death
        SD                  shoulder disarticulation
        seg                 polymorphonuclear neutrophil
        SGOT                serum glutamic-oxaloacetic transaminase
        SGPT                serum glutamic-pyruvic transaminase
        SH                  serum hepatitis
        SLE                 systemic lupus erythematosus
        SOB                 shortness of breath
        SOS                 if necessary
        sp. gr.             specific gravity
        SR                  sedimentation rate
        St                  strabismus (esotropia)
        staph               staphylococcus
        stat                immediately
        STD                 sexually transmitted disease
        strep               streptococcus
        subcu,subq          subcutaneous
        Svc                 superior vena cava
        SVD                 spontaneous vaginal delivery
        T                   temperature
        TI, 72 to T12       first thoracic vertebra, second thoracic vertebra through twelfth thoracic vertebra
        T3                  triiodothyronine
        T4                  thyroxine
        TAH                 total abdominal hysterectomy
        TandA               tonsillectomy and adenoidectomy
        TB                  tuberculosis
        THA                 total hip arthroplasty
        THR                 total hip replacement
        TIA                 transient ischemic attack
        tid                 three times a day
        TKA                 total knee arthroplasty
        TKR                 total knee replacement
        TNM                 tumor, nodes, metastasis
        top                 topically
        TPN                 total parenteral nutrition
        TPR                 temperature, pulse, and respiration
        TPUR                transperineal urethral resection
        TSH                 thyroid-stimulating hormone
        TSS                 toxic shock syndrome



Abbreviation      Meaning

                                                    Page 246
TUR, TURP   transurethral resection of the prostate
TX          tumor cannot be assessed
U           units
UA          urinalysis
UC          uterine contractions
UGI         upper gastrointestinal
ULQ         upper left quadrant
ung         ointment
URI         upper right quadrant
UTI         urinary tract infection
UV          ultraviolet
VA          visual acuity
VC          vital capacity
VD          venereal disease
VF          visual field
VHD         ventricular heart disease
VLDL        very-low-density lipoprotein
VSD         ventricular septal defect
WBC         white blood cell (count); white blood count
wt          weight
w/v         weight by volume
x           multiplied by
XP          xeroderma pigmentosa
XT          exotropia
XX          female sex chromosomes
XY          male sex chromosomes




                                             Page 247
Appendix 7
Documentation Guidelines for Evaluation
and Management
Services



This is an update of the guidelines jointly produced by the American Medical
Association (AMA) and HCFA in May, 1997. It incorporates revisions to the
gastrointestinal section of the general multi-system exam and the skin section of the
single organ system exam of the skin. These revisions were approved by the AMA
and HCFA in November, 1997.




      American Medical. Association
  Health Care Financing Administration
              NOVEMBER, 1997




                                      Page 248
B.     DOCUMENTATION OF EXAMINATION                        `

The levels of E/M services are based on four types of examination:

•      Problem Focused -- a limited examination of the affected body area or organ
system.
•      Expanded Problem Focused -- a limited examination of the affected body area or
       organ system and any other symptomatic or related body area(s) or organ
system(s).
•      Detailed -- an extended examination of the affected body area(s) or organ
       system(s) and any other symptomatic or related body area(s) or organ system(s).
•      Comprehensive -- a general multi-system examination, or complete examination
of
       a single organ system and other symptomatic or related body area(s) or organ
system(s).

These types of examinations have been defined for general multi-system and the
following single organ systems:

•      Cardiovascular
•      Ears, Nose, Mouth and Throat
•      Eyes
•      Genitourinary (Female)
•      Genitourinary (Male)
•      Hematologic/Lymphatic/Immunologic
•      Musculoskeletal
•      Neurological
•      Psychiatric
•      Respiratory
•      Skin

A general multi-system examination or a single organ system examination may be
performed by any physician regardless of specialty. The type (general multi-system or
single organ system) and content of examination are selected by the examining physician
and are based upon clinical judgment, the patient's history, and the nature of the
presenting problem(s).




                                       Page 249
The content and documentation requirements for each type and level of examination are
summarized below and described in detail in tables beginning on page 13. In the tables,
organ systems and body areas recognized by CPT for purposes of describing
examinations are shown in the left column. The content, or individual elements, of the
examination pertaining to that body area or organ system are identified by bullets (•) in
the right column.

Parenthetical examples, "(eg, ...)", have been used for clarification and to provide
guidance regarding documentation. Documentation for each element must satisfy any
numeric requirements (such as "Measurement of any three of the following seven...")
included in the description of the element. Elements with multiple components but with
no specific numeric requirement (such as "Examination of liver and spleen") require
documentation of at least one component. It is possible for a given examination to be
expanded beyond what is defined here. When that occurs, findings related to the
additional systems and/or areas should be documented.

• DG: Specific abnormal and relevant negative findings of the examination of the
affected or symptomatic body area (s) or organ system (s) should be documented. A
notation of "abnormal" without elaboration is insufficient.

• DG: Abnormal or unexpected findings of the examination of any asymptomatic body
area(s) or organ system(s) should be described.

• DG: A brief statement or notation indicating "negative" or "normal” is sufficient to
document normal findings related to unaffected area(s) or asymptomatic organ
system(s).

GENERAL MULTI SYSTEM EXAMINAT10NS

General--multi-system examinations are described in detail beginning on page 13. To
qualify for a given level of mufti-system examination, the following content and
documentation requirements should be met:

•      Problem Focused Examination-should include performance and documentation
       of one to five elements identified by a bullet (•) in one or more organ system(s) or
body area(s).
•      Expanded Problem Focused Examination-should include performance and
       documentation of at least six elements identified by a bullet (•) in one or more
       organ system(s) or body area(s).




                                        Page 250
•      Detailed Examination--should include at least six organ systems or body
areas.
       For each system/area selected, performance and documentation of at least two
       elements identified by a bullet (•) is expected. Alternatively, a detailed
examination
       may include performance and documentation of at least twelve elements
       identified by a bullet (•) in two or more organ systems or body areas.

•      Comprehensive Examination--should include at least nine organ systems or
       body areas. For each system/area selected, all elements of the examination
       identified by a bullet (•) should be performed, unless specific directions limit the
       content of the examination. For each area/system, documentation of at least two
       elements identified by a bullet is expected.

SINGLE ORGAN SYSTEM EXAMINATION
The single organ system examinations recognized by CPT are described in detail
beginning on page 18. Variations among these examinations in the organ systems and
body areas identified in the left columns and in the elements of the examinations
described in the right columns reflect differing emphases among specialties. To qualify
for a given level of single organ system examination, the following content and
documentation requirements should be met:
•       Problem Focused Examination--should include performance and documentation
        of one to five elements identified by a bullet (•), whether in a box with a shaded
        or unshaded border.

•.     Expanded Problem Focused Examination--should include performance and
       documentation of at least six elements identified by a bullet (•), whether in a box
       with a shaded or unshaded border.
•      Detailed Examination--examinations other than the eye and psychiatric
       examinations should include performance and documentation of at least twelve
       elements identified by a bullet (•), whether in box with a shaded or unshaded
       border.




                                        Page 251
               Eye and psychiatric examinations should include the performance
               and documentation of at least nine elements identified by a bullet
               (•), whether in a box with a shaded or unshaded border.
•      Comprehensive Examination--should include performance of all elements
       identified by a bullet (•), whether in a shaded or unshaded box. Documentation of
       every element in each box with a shaded border and at least one element in
       each box with an unshaded border is expected.
Multi-System Screening Examination

1.     Check height and weight
2.     Wash hands
3.     Inspect general appearance
4.     Check oral temperature
5.     Palpate count compare radial pulse
6.     Count respiratory rate
7.     Measure blood pressure
8.     Inspect skin, nails, joints
9.     Inspect head and face
10.    Check visual acuity CNII
11.    Inspect eyes
12.    Test pupillary reaction to light and accommodation
13.    Test ocular muscles
14.    Test ocular movements CN III, IV, VI
15.    Fundoscopic exam
16.    Check auditory acuity CN VIII
17.    Examine external ears
18.    Otoscopy
19.    Examine nose and sinuses
20.    Inspect pharynx and have patient phonate CN IX, X, XII
21.    Inspect lips, tongue, teeth, buccal mucosa
22.    Palpate thyroid
23.    Examine posterior chest
24.    Check tactile fremitis
25.    Percuss posterior and lateral chest
26.    Auscultate posterior and lateral chest
27.    Percuss anterior lung fields
28.    Auscultate anterior lung fields
29.    Inspect and palpate precardium
30.    Percuss cardiac border
31.    Auscultate heart
32.    Auscultate carotids
33.    Auscultate abdomen and mid-epigastrium
34.    Auscultate femoral areas
35.    Palpate carotid arteries
36.    Palpate femoral pulses
37.    Palpate posterior tibial and dorsalis pedis pulses

                                       Page 252
38.   Check for pre-tibial edema
39.   Inspect abdomen
40.   Palpate abdomen
41.   Palpate bimanually for liver
42.   Palpate bimanually for spleen
43.   Palpate for femoral hernia
44.   Palpate neck for nodes
45.   Palpate axillary nodes
46.   Palpate epitroclear nodes
47.   Palpate inguinal nodes
48.   Test ROM of cervical spine
49.   Test ROM of lumbar spine
50.   Percuss spine and renal angles
51.   Test ROM of upper extremities bilaterally
52.   Test ROM of lower extremities bilaterally
53.   Examine joints
54.   Test CN V sensory and motor
55.   Tests CN VII motor
56.   Test CN XI motor
57.   Test biceps and triceps reflexes
58.   Test patellar and achilles reflexes
59.   Test for fine touch and pinprick on extremities
60.   Check gait
61.   Assess judgment and insight
62.   Assess orientation to person, place, time
63.   Assess recent and remote memory
64.   Assess mood




                                    Page 253
MULTI SYSTEM EXAMINATION
Patient Name____________________________ Doctor_________________________
Date_____________________

CONSTIT      Vitals    (perform 3)   B.P.                  Pulse              RR
UTIONAL                              Temp                  Ht.                Wt.
             General                 No deformities        Appears neat and   Appears well
             appearance              noted                 well groomed       nourished

PSYCH        Oriented X 3                                                     Notes:
             Recent and remote memory intact
             No mood disorders noted
             Judgment and insight WNL
SKIN         No scars, rashes, ulcers, discoloration or lesions noted.
             No in duration, sub-Q nodules, tightening.

EYES         Sclera white, conjunctive clear, no lid lag
             PERRLA (direct and consensual B/L)
             Discs flat, no exudate, no hemorrhage, vessels intact
             Extra-occular movements intact B/L
             Visual fields by confrontation WNL B/L
             Visual acuity intact B/L
EARS,        No scars, lesions, or masses on ears
NOSE,        Hearing intact B/L
THROAT       Tympanic membranes translucent, non-bulging.
             Canal walls pink no discharge
             Mucosa and turbinates pink. Septum midline,
             no sinus tenderness
             Lips pink and symmetrical, gums pink, good dentition
             Oral mucosa pink and moist. Tongue moist, no ulcers.
             Pharynx pink, no exudate, lesions or inflammation.
NECK         Full ROM, trachea midline, no masses
             No thyromegaly
RESPIRA-     Respiration even and un-labored
TORY         Lung fields: No flatness, dullness, or hyperresonance
             Tactile fremitus absent
             Clear/equal, no adventitious sounds B/L
CARDIO-      No lifts, heaves, thrills. PMI present.
VASC.        Percussion of cardiac borders WNL.
             RRR no murmurs, rubs, gallops, S1 and S2 WNL
             Carotids, femoral No bruits
             Abdominal aorta No bruits               Size__________
             Politely, tibias and pedals WNL B/L
             Carotids, brachial, radials WNL B/L
             No edema or varicosities




                                       Page 254
A         No masses, tenderness or hernias noted.                  Notes:
B         Percussion WNL Bowel sounds intact x 4 quads.
D         Liver and spleen w/out tenderness or enlargement.
O         CVA tenderness absent B/L
M         Rectal: even sphincter tone, no       Not indicated
E         hemorrhoids or masses.
N         Hemoccult negative.                   Not indicated
MUSCULOSKE      Gait                            Coordinated and
L                                               smooth.
                Digits                          No clubbing,
                                                cyanosis, or
                                                lesions.
                Grip Strength                   WNL B/L
                Joints/bones/muscle             Joints intact.
                ___Head/neck
                ___Spine/rib/pelvis             Joints w/ full
                ___R upper extremity            ROM No pain,
                ___L upper extremity            crepitus, or
                ___R lower extremity            contracture.
                ___L lower extremity            No misalignment,
                (minimum 1 of above)            deformity, defects
                                                or subluxation.
                                                No muscle
                                                atrophy/weakness.
NEURO-LOGICAL                   Cranial Nerves Intact B/L
                                  I-XII
                                  Sensation             WNL B/L
                                  Torso/extremities
                                  (touch, pain,
                                  vibration,
                                  position)
                                  Reflexes              WNL B/L
                                  (biceps, triceps,
                                  patellar, achilles)
                                  Babinski              Downgoing
                                  Romberg               WNL
                                  Heel to               WNL
                                  shin
LYMPH                             ___Neck               Areas palpated not
(Choose 2)                        ___Axilla             enlarged

                                  ___Groin
                                  ___Other
FEMALE                   Vulva No masses, lesions, scars,
                         swelling, or rashes


                                      Page 255
                                   Labia, clitoris,vaginal orifice, and
                                   urethral meatus:            All intact
                                   w/out discharge
                                   Bladder Non-bulging, non-tender
                                   Cervix Pink w/out lesions, discharge,
                                   odor
                                   Uterus Midline, non-tender, firm and
                                   smooth
                                   Pelvis No masses or tenderness
                                   Femoral hernia: Absent B/L
 CHEST                                           Breasts Symmetrical


                                                     Breasts No masses,
                                                     lumps, discharge,
                                                     tenderness
 MALE                                    Scrotum: No masses, swelling,
                                         tenderness
                                         Penis: No discharge
                                         Circ_______ Uncirc________
                                         Prostate: Symmetrical. No
                                         tenderness, enlargement, nodularity
                                         Inguinal canal: No hernia B/L
Comprehensive: >2 bullets from 9 areas Detailed: >2 bullets from 6 areas/ or 12 bullets from >2 areas Expanded: > 6
bullets Problem focused: 1-5 bullets               (*) = See attached notes




                                                  Page 256
Appendix #8
Co-management: templates and etiquette guidelines

In order to facilitate professional and appropriate communications between Bastyr Center
for Natural Health providers and other healthcare providers, we all need to use similar
standards for referral and treatment summary letters. Following this introduction, you
will find copies of a model for a treatment summary letter, a model for a referral-to-a-
specialist letter, and examples of both letters.
The following are elements of professional etiquette:
1. It is customary to write a treatment summary letter to the referring primary care doctor
shortly after the first referred visit. If the initial strategy of the case management can
only be summarized after several visits, the treatment summary may be completed after
the 2nd or 3rd visit. This summary letter is applicable to all referrals from primary care
doctors.
2. After you have received written consent from the patient, you should write a treatment
summary to this patient’s primary care doctor even if the patient is seeing you outside of
a referral. This is essential for safe and effective co-managed care.
3. You should periodically send treatment summary updates to the patient’s primary care
provider. The interval of these letters is dependent upon the nature of the case.
3. Treatment summary letters to primary care doctors may not instruct the primary care
doctor in the care of the patient. Treatment summary letters summarize your findings and
management in order to inform the primary care physician. You should not recommend
general screening tests or interventions outside the scope of the referral to the patient or
to the referring primary care physician. You may inquire about the primary care
physician’s intended screening or case management strategies. The language of treatment
summary letters should be deferential; after all, you are seeing “their” patient as a
specialist.
4. If you are the primary care physician writing a letter to a specialist, it is important to
summarize all relevant findings so that the time your patient spends with the specialist is
productive and effective. Your letter should be instructive and should contain copies of
relevant diagnostic reports.




                                         Page 257
Today’s date

Dr. name of referring doctor
Address of referring doctor

RE: patient name      DOB: of patient                ICD-9: referred ICD diagnosis

Dear Dr. name of referring doctor,

We thank you for the opportunity to see your patient, Jane Doe, for complementary
naturopathic care at Bastyr Center for Natural Health – Team Care.

HX: Start with a statement of the total number of visits and the dates of the visits. Re-
state presenting CC, which must be the same as the referred diagnosis. Discuss history
of present illness (i.e. summary of chief complaint attributes). Also list relevant and
associated secondary diagnoses/complaints.

ROS (significant): List significant past medical history as well as pertinent negatives.

PMHX: List significant past medical history

FAM HX: List significant family history

MEDS/SUPPLMNTS: Upon initial visit, list the medications and supplements patient
was taking. List any known allergies to medications in CAPITAL FONT.


PE: Summary of relevant PE findings at first visit

MNGMNT: Summary of case management, including responses to treatments, new PE
findings, and progression of treatments.

RECOMMENDATIONS: Overall summary of patient response to
naturopathic/acupuncture/nutrition treatment and your request for additional referrals if
necessary.

Please contact us if you have any further questions or concerns.

Sincerely,


Supervisor name, ND or LAc or RD                             Primary Clinician / Intern
name
Supervising Faculty                                          Student clinician
CC: patient


                                        Page 258
13 November 2001

Dr. Primary Care Doctor
1001 1st Ave.
Seattle, WA 98111

RE: Jane Doe        DOB: 1/1/01                   ICD-9: 564.1 (irritable bowel syndrome)

Dear Dr. Primary Care Doctor,

I thank you for the opportunity to see your patient, Jane Doe, for complementary naturopathic care at Bastyr Center for
Natural Health – Team Care.

HX: I have seen Jane Doe three times (2/3/01, 3/8/01, and 4/15/01). She first presented on 2/3/01 with a diagnosis of
irritable bowel syndrome (564.1). On February 3rd, Ms. Doe reported that her IBS symptoms began during the winter of
1999. She experienced 2 episodes of the stomach flu within 1 month of each other. Subsequent to these flu episodes,
Ms. Doe has experienced gastrointestinal problems. She described constant eructation, sore and irritating pressure in
her epigastric area, and flatulence. Her symptoms present somewhat intermittently without any identifiable pattern. She
reported that she had been tested negative for giardia and H. pylori. She also has had a negative endoscopy and biopsy.
Finally, a 24-hour pH test revealed weakened LES and a gastric emptying test revealed delayed gastric emptying. Ms.
Doe explained that antacids and doxepin were mildly helpful in temporarily alleviating her symptoms. She also
informed me that various food eliminations and a decrease in caffeine and alcohol were somewhat helpful. Ms. Doe
expressed concern that this past summer, she experienced two episodes of diarrhea, which was a new symptom for her.
Ms. Doe denied stabbing, crampy, or burning pain. She denied nausea or vomiting. She reported 2-3 bowel movements
weekly that were well formed and without abnormalities. In general, Ms. Doe reported excellent lifestyle habits. Her
diet was sufficient in calories, although very limited in variety. She reported regular exercise and sleep. Ms. Doe’s
primary goal was to regain normal, asymptomatic digestive function.

ROS (significant): History of dysthymia; currently mild. No significant symptoms reported with regards to
cardiovascular, dermatological, musculoskeletal, urinary, or reproductive functions.

PMHX: Ms. Doe had a benign breast cyst diagnosed in July 2001. Ms. Doe reported PMS symptoms for which she
recently has been prescribed oral contraceptives.

FAM HX: Mother with HTN, diagnosed at age 45. Paternal grandfather with ulcerative colitis.

MEDS/SUPPLMNTS: Upon initial visit – LoEstrin 28, B vitamin supplement (50 mg daily), Calcium supplement
(1500 mg daily). ALLERGIC TO ERYTHROMYCIN.

PE: bp: 100/64, p: 52; reg., t: 98.3, rr: 16. Heart: rrr, no extra sounds. Thyroid: non-palpable. Abdomen: bs x 4; no
shifting dullness, no masses, negative hepatic or splenic enlargement, mild tenderness to deep palpation of RLQ and
suprapubic regions.

MNGMNT: Based upon the presentation of the IBS symptoms and the onset of the symptoms after repeated viral
infections, we presumed that the IBS symptoms developed as a result of intestinal dysbiosis, decreased intestinal
mucosal integrity and an associated prostaglandin pro-inflammatory imbalance. At Ms. Doe’s first visit, we
recommended oral acidophilus supplementation (HMF Forte), a digestive stimulant, mild laxative, and carminative
herbal tincture (Rumex crispus: Foeniculum vulgare), an extract of licorice (Glycyrrhiza glabra) for its anti-
inflammatory and mucosal healing properties, and an omega-3 fatty acid supplement. After a month on this plan, Ms.
Doe returned on March 8th , when she reported some improvement. She was having a bowel movement every other day
and was experiencing a concomitant decrease in flatulence. Her abdominal discomfort was still present, however, it was
decreased in intensity. She reported no change in her eructation. She also reported a 14-day menses after taking the oral
contraceptives for 2 weeks. She was fully compliant with the treatment. Based upon this response, we recommended
that she continue with the current plan with the exception of the licorice extract, which we discontinued. We
recommended the addition of Filipendula officinalis herbal tincture (gastrointestinal nervine, herbal antacid, and anti-
inflammatory) and a plant-based digestive enzyme supplement. We recommended that she increase the variety of
vegetables and fruit in her diet. Ms. Doe returned in another month on April 15th. At this visit, she reported some
further improvement in her abdominal discomfort, flatulence and reported that she was not burping as frequently as
previously.




                                                     Page 259
 Overall, she estimated her improvement at 50%. Most of her symptoms only occurred with the consumption of certain
foods, namely some raw vegetables, pizza, and chocolate chip cookies. At this visit, we discussed Ms. Doe’s stress level
and determined that, despite excellent stress management practices; she tended to internalize work stress. At this point,
we surmised that the dysbiosis and mucosal integrity of her intestinal track were somewhat improved. However, we
suspected that her internalized stress and physiologically caused inflammation from certain foods were triggering
increased levels of CRF and associated IL-1 release. These molecules are known to bind to 5-HT receptors in the
digestive tract causing constipation and diarrhea depending on the receptor subtype. We further suspected that her
symptoms were aggravated by functional HCl and pancreatic enzyme deficiencies given the preponderance of eructation
and the epigastric discomfort. Based upon these suspected etiologies of her IBS, we recommended that Ms. Doe
continue the acidophilus, omega-3 and pancreatic enzymes. We made new recommendations for nervine and
adaptogenic botanicals (Eleutherococcus senticosus and Avena sativa) and betaine HCl. Finally, we emphasized the
importance of additional stress management at work and shared some additional techniques with Ms. Doe.

RECOMMENDATIONS: It appears as though Ms. Doe is responding well to naturopathic treatment of her irritable
bowel syndrome. We suspect that Ms. Doe will need additional time for the healing process to continue. We would
very much like to continue to support Ms. Doe with naturopathic medical treatment. An additional referral for 3 visits to
begin in July 2001 and to occur over a time period of 6 months would best enable us to provide this naturopathic care to
Ms. Doe.

Please contact us if you have any further questions or concerns.


Sincerely,



Lise Alschuler, ND                                                             Happy Student
Supervising Faculty                                                   Student Clinician

CC: Jane Doe




                                                      Page 260
Date

Doctor Name
Doctor Address

RE: patient name                   DOB: patient birthdate                        Social Security
number: of patient

Dear Dr.

I am referring ____ to you for further evaluation of symptoms consistent with (diagnosis or
presumptive diagnosis with ICD-9).

Pertinent Hx: List HPI, relevant PMHx, relevant ROS, and relevant FamHx

Physical Exam and Labs: List significant findings

Interventions: List all current medications and supplements. (Include statement
regarding any known drug allergies)

Impression: List suspected rule-outs, requested evaluations, examinations, follow-up.

In regard to evaluation of this patient, please provide us with the following:

_____ a brief written report on findings (with verbal report if necessary).

_____ treatment as indicated.

_____ periodic status reports on the patient if she/he remains under your care.


Thank you for agreeing to see _______. If further information is needed, please contact Dr. _(ND
supervisor)__ at doctor’s phone #. Thank you so much for your help in the care of this patient.

Sincerely,
        Appointment on:____________@_______

Doctor Name
        Student clinician name
Supervising Faculty
        Student Clinician

CC: Patient




                                              Page 261
Dr. GI Specialist
GI Specialist Building
1 1st Ave.
Seattle, WA 98111

November 5, 2001

RE: Jane Doe                   DOB: 2/3/50         SS#: 202-20-0220

Dear Dr. GI Specialist,

I am referring Jane Doe to you for further evaluation of symptoms consistent with abdominal pain (789.00), possibly
indicative of chronic appendicitis, carcinoma of the colon, Crohn’s disease, ovarian cysts, or other space-occupying
lesion.

Pertinent Hx:        Ms. Doe first presented with abdominal pain on September 22, 2001. She reported that she had
experienced intermittent abdominal pain since March of 2001. The pain was located in her right lower quadrant. She
described it as achy, occasionally sharp. The pain was noticeably worse prior to menses, in the morning upon waking.
She reported some relief with hot showers. She described associated discomfort in her low back. She also described a
4-month history of constipation, with one difficult to pass bowel movement every 3rd day. She denied association of her
abdominal pain with defecation or eating. Her menses is regular every 23 to 26 days. She also denied fever, nausea, or
bloating. Ms. Doe has a long-standing history of GER with ingestion of certain foods and is status post cholestectomy in
1999 secondary to cholelithiasis. During my most recent visit with Ms. Doe, on October 3rd, she reported that her
abdominal pain was more frequent (daily) and was worse than previously in the mornings. In a recent phone call, Ms.
Doe reported that her pain had become more severe and more constant. She reported being awakened by her pain after
more than 3 hours of sleep. Sitting up provided some relief. Other pertinent history includes moderate obesity,
cholethiasis (cholestectomy 2000) with splenic enlargement in 2000 (see enclosed ultrasound report), and microcytic
anemia (diagnosed 9/25/01).

Physical Exam and Labs Physical examination on October 31, 2001 revealed the following significant findings:
Abdominal examination: normal b.s. x 4 but diminished, no masses, tenderness to deep palpation of RLQ and pain
reported in RLQ upon deep palpation of LLQ, -HSM
Gynecological examination: without abnormalities. Uterus was partially palpable without tenderness or apparent
enlargement. Ovaries were not palpable bilaterally; however deep palpation did not elicit any discomfort.

Interventions: Ms. Doe has been taking a multivitamin and an herbal lipotropic formula for a long period of time. On
October 3rd, 2001, she began taking Iron citrate (200 mg elemental iron daily). Ms. Doe has no known drug allergies.

Impression: I am concerned about the worsening pain pattern that Ms. Doe is experiencing. I am also concerned about
the recent finding of microcytic anemia. In particular, I would like to rule out colonic carcinoma, appendicitis or colitis.
In light of the worsening symptoms, I have also scheduled an abdominal CT for Ms. Doe on October 20th , 2001. I will
have the written report of this CT faxed to you as well.

In regard to evaluation of this patient, please provide:
_____ a brief written or verbal report on findings.
_____ diagnostic work-up as indicated.
_____ periodic status reports on the patient if she/he remains under your care.

Ms. Doe has an appointment with you on October 28th, 2001.

Your recommendations would be appreciated. If further information is needed, please contact me. Thank you so much
for your help in the care of this patient.

Sincerely,

Lise Alschuler, N.D.                                                                        Happy Student
Supervising Faculty                                                                Student Clinician

CC: patient
Encl: Abdominal ultrasound written report of 2/99; CBC with differential of 9/25/01.



                                                       Page 262
Appendix # 9




Naturopathic Treatment of Malignancy Consent Form
In accordance with the Washington state licensing law of naturopathy, naturopathic doctors may
treat malignancy only in concert with an M.D. or D.O.

I, ______________________, request naturopathic care at the Bastyr Center for Natural Health.
       (patient’s name)

An oncologist has diagnosed me with _________________________ cancer.
                                         (type of cancer)

I am currently under the care of Dr. ________________________________ (M.D. or D.O.) for
my cancer.                                        (name of doctor)

I understand that Washington law requires that any naturopathic care that I receive at the Bastyr
Center for Natural Health for the treatment of cancer be rendered in concert with a medical or
osteopathic doctor. My signature below attests to my understanding of this important
relationship between my health care professionals and my commitment to cooperate with my
care providers in this collaborative treatment.


                                          Date


Patient’s Name (Print)                    Guardian’s Name (Print)


Patient’s Signature                       Guardian’s Signature




                                        Page 263

								
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