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Audiology Clinic Handbook C tinnitus

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					Department of Communications Sciences and Disorders
            Doctor of Audiology Program

          Clinical Policies and Procedures




      SUMMER 2008 THROUGH SPRING 2009




                        1
      TABLE OF CONTENTS

      TOPIC                                       PAGE


Introduction                                      3

I. The Facility                                   5

II. Services Provided                             7

III. Patient Appointments                         8

IV. After Scheduling the Patients                 10

V. Patient Fees                                   11

VI. Superbill                                     17

VII. Collection of Fees                           25

VIII. Clinic Equipment                            26

IX. Patient Files                                 33

X. The Appointment                                37

XI. After the Appointment                         46

XII. Patient Reports                              50

XIII. Requests of Patient Reports and Information 53

XIV. Other Important Information                  55

XV. Grading, Clinical Assistance Program,         57
      KASA Competencies, Practical Exam

XVI. The Student                                  59




                                              2
INTRODUCTION

    The audiology practicum assignments are an essential educational component of the
    audiology doctoral program. This handbook is designed to acquaint students with
    clinical policies and procedures for the USF Hearing Clinic. It will serve as a reference
    throughout the students‟ in-house clinical experience.

    Non-Discriminatory Policy

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

    Confidentiality

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

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

    Prerequisites for clinic enrollment

           Speech-Hearing Screening

                  Each student in the Department must have a speech and hearing
                  proficiency check prior to enrollment in practicum. This screening must be
                  completed during the first semester of enrollment as an audiology doctoral
                  student if not completed at USF in SPA 4050. Any student admitted to the
                  program who has NOT had this check, will not be enrolled in practicum.

           Observation Hours and CPR Certification

                  All students should have documentation of 25 hours of observation
                  experience before being enrolled in practicum. Documentation of the
                  completion of these hours must be submitted to the Audiology Clinic
                  Director by the end of the spring semester of the first year of the audiology
                  doctoral program. Documentation must be in the form of an observation



                                                  3
log or letter, on letter head, from the program confirming the observation
hours. It must contain an original signature of the person who certified the
hours as well as their ASHA number. Xeroxed copies will not be accepted,

In addition, all students must have documentation of training in community
CPR (infant, child, and adult) and HIV or must complete training prior to
initiation of practicum. While enrolled in in-house clinic, documentation
must be submitted to the Audiology Clinic Director.




                              4
I. THE FACILITY

     Audiology Clinic

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

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


                            Room                            Room #
                            Audiology suites                1008- A-D
                            Foyer                           1008
                            Hearing Aid Room #1             1010
                            Hearing Aid Room #2             1001
                            Cochlear Implant Room           1005
                            Audiological Rehabilitation     1006
                            Room
                            Audiology Clinic Assistant‟s    1017
                            Area
                            Student Work Room               1015
                            Waiting Area
                            Conference Room                 1007
                            Clinical Supervisors‟ Room      1002


     Audiology Suites

             Four sound treated booths :
                   A and D are used when testing pediatric patients and CI patients
                   B and C are used when testing adult patients

     Foyer

             Contains an open area used for otoscopy and immittance testing

     Conference Room

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



                                                 5
Student/Patient Window

      This window, located in the PCD 1017 lobby is to be used by the student clinician
      to check for patient arrival and to request other needed information.

Audiology Clinic Assistant’s Area (PCD 1017)

      This area houses the audiology clinic assistant‟s workstation, clinic files, forms,
      etc.

      Student discussions and meetings with supervisors will not be held in this area.
      Other rooms will be available for this purpose.


      Closed circuit television setups for observation and videotaping are available at
      two of the workstations . These are not to be used by the students without explicit
      approval by a supervisor.


      Students are to enter and exit this area from the student workroom side of PCD
      1017 and not from main waiting area side of the clinic. In addition, students are to
      knock on the door before entering this area.

Student Work Room

      Student clinicians are to perform activities in this room related to the clinic
      patients. These activities may include:
             Wait for patient arrival
             Review of patient files
             Completion of patient files
             Writing reports
             Review clinical and testing procedures
             Complete other supervisor assigned activities

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

      The computer is available only for report writing

      Food and drink are allowed in this room only for the students on the first floor




                                             6
II. SERVICES PROVIDED

     Audiology Clinic Services

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

           Audiological evaluations and re-evaluations
           Hearing aid evaluations, hearing aid consultations, and hearing aid repair
           Electrophysiological evaluations
           Aural Rehabilitation and Auditory Processing Disorders Treatment
           Cochlear implant evaluations/mapping/programming
           Auditory processing evaluations.
           Tinnitus evaluation and treatment

        These services are provided to patients of all ages. Length of appointment may vary
        from 15 minutes to 1 ½ hours depending on the service(s) provided; this is left up to
        the discretion of the clinic supervisor.




                                                7
III. PATIENT APPOINTMENTS

       A. Scheduling Patient Appointments

                All services provided by the USF Audiology Clinic should be scheduled through
                the audiology clinic administrative assistant. It is important that the
                administrative assistant schedule the appointments to allow for smooth
                operation of the clinic and avoid overbooking of patients needing various
                services.

                Appointments may be made over the phone, via email, or at the audiology
                clinic window located at PCD 1017.

                It is important to maintain the quality of service provided to patients and the
                execution of an efficient clinic to schedule patients with the appropriate doctor.

                Note that there are predetermined numbers of APD and CI patients per
                semester. When these numbers are met, obtain the patient‟s name, phone
                number and concern, and give the message to the appropriate doctor.

                The following chart shall be used to determine the proper audiologist for
                scheduling purposes:

              PED   ABR   APD   CI   HAE      HAFU     HAR     HE      ADULTS ABR       APD   CI   HAE   HAFU   HAR   HE

 Carr                X     X                                       X
 Lister                    X                                       X
 Menendez                                                                           X               X      X     X     X
 Muscato                         X                                                             X
 Richardson          X                 X        X         X        X                X               X      X     X     X
 Zelski                                                                             X               X      X     X     X

                                     Codes:
                                     ABR             Auditory Brainstem Response
                                     APD             Auditory Processing Disorder
                                     CI              Cochlear Implant
                                     HAE             Hearing Aid Evaluation
                                     HAFU            Hearing Aid Follow Up
                                     HAR             Hearing Aid Repair
                                     HE              Hearing Evaluation


                The appointment book will be located on the Audiology clinic administrative
                assistant‟s work station in PCD 1017. Each scheduled appointment will include
                the patient‟s name, phone number, and type of appointment. The assistant will
                schedule the appointments. If she is not available a clinic supervisor may
                schedule.

                If the patient is a pediatric patient, his/her age will also be recorded.


                                                               8
     The type of appointment is coded using the following designators:
           Aud Dx – audiologic diagnostic
           HAE – hearing aid evaluation
           HAFU – hearing aid follow up
           HA - hearing aid check
           HA repair - hearing aid repair
           HAF – hearing aid fitting
           CI eval – cochlear implant evaluation
           CIA – cochlear implant activation
           CIFU – cochlear implant follow up
           CI TR – cochlear implant troubleshooting/repair
           AP eval – auditory processing evaluation
           ABR – Auditory Brainstem Response study

     The audiology clinic administrative assistant will complete an “Intake Form”
     (See forms for the USF Hearing Clinic) for patients new to the clinic. For
     returning patients, the “Returning Patient-Reason for Appointment Form” will
     be completed. These will be placed in the patient‟s file prior to the scheduled
     appointment.

     In addition, the audiology clinic administrative assistant will provide the patient
     with specific directions to the Psychology/Communication Disorders (PCD)
     building, information about where to park, and instructions for obtaining a parking
     pass upon their arrival.

     Patients will be advised to arrive at least 15-30 minutes early to allow time for
     parking, checking in, and the completion of forms. As an alternative, the
     audiology clinic administrative assistant will mail appropriate forms (map, case
     history, etc.) to the patient if there is sufficient time before the appointment.

     The audiology clinic administrative assistant will post the clinic schedule in the
     student workroom (PCD 1015) and on the bulletin board located in PCD 1017 on
     Thursday for the following week. Changes in the schedule will be recorded on the
     schedule as they arise. It is the responsibility of the student to check the clinic
     schedule frequently as the schedule is subject to change.


B. Confirming Patient Appointments

     The audiology clinic administrative assistant will handle confirmation of
     appointments. Appointments for patients seen Tuesday through Thursday will be
     confirmed the day before the appointment and Monday‟s appointments will be
     confirmed on the Friday before the appointment. Patients will be contacted via
     telephone and in some cases via email. After a patient appointment has been
     confirmed, a “C” will be recorded to the left of the patient‟s name or “LM” when
     they have left a message



                                           9
VI. AFTER SCHEDULING THE APPOINTMENT

     A. New Patients

           If the patient‟s appointment is 7 or more days away the audiology administrative
           assistant will mail out the necessary forms; these may include a case history
           form, directions and map to PCD 1017, and a parking pass. She will mark on the
           “Intake” form which forms were sent.

           A temporary patient file will be created by the assistant. This file will contain the
           “Patient Fee Statement” form, the “Record of Reports/Letters Sent” form, and the
           patient‟s “intake” form. The patient‟s name and date of the appointment will be
           written in pencil on the file‟s tab. The file will be placed alphabetically in the
           “Scheduled for Evaluation” section in the filing cabinet designated for reports
           in progress and scheduled patients

     B. Returning Patients
           The audiology office assistant will locate the patient‟s file, insert the “returning
           patient” form, and place the file alphabetically in the “Scheduled for Evaluation”
           section in the filing cabinet designated for reports in progress and scheduled patients.
           .




                                                 10
V. PATIENT FEES

     Note # 1: Below is new pricing, effective January 7, 2008 to reflect a more realistic
     billing strategy.

     Note # 2: To determine fees for diagnostic services provided, the student is to refer to
     the fee schedules located in the front of the “Biological Listening Check Notebook”
     found in each audiology suite. Fees are assigned by the type of patient seen as shown
     below.

     Note # 3: Charges to a patient different from those below for a “Basic Comprehensive
     Evaluation” will need to be approved by the clinic director and a fee waiver signed. A
     copy of the signed fee waiver will be placed in the patient‟s file and the original will be
     placed with the yellow copy of the superbill.


     A. Diagnostic Services

            Adult Patients:

            Using this policy the value of procedures performed as the basic audiologic
            evaluation for adults totals $265.00. A basic comprehensive audiologic
            evaluation consists of the following CPT Codes and descriptors:

                 92557 Basic Comprehensive Audio (air and bone pure tone audiometry
                        and speech audiometry)
                 92566 Immittance Audiometry (tympanometry and ipsilateral and
                        contralateral acoustic reflexes)
                 92569 Acoustic Reflex Decay
                 92587 Evoked OAE (limited otoacoustic emissions)

            Because this is a student training facility and procedures are done by Au.D.
            students all adult patients will be charged $115.00 rather than $265.00. The
            following exceptions will be made:

                   USF students – No charge (Difference of $115.00)

                   USF faculty/staff – No charge (Difference of 115.00)

                   Spouse/Family member of USF Faculty/Staff – $50.00 (Difference of $65.00)

                   HCC students seen as part of their educational programs – $15.00
                      (Difference of $100.00)

                   Patients referred as a result of USF screening – $50.00 (Difference of $65.00)




                                                  11
          Patients seen from USF Physical Plant - $25.00 (Difference of $90.00)

          Patients seen from USF Comparative Medicine Department – $95.00
              (Difference of $20.00)

          Patients referred from USF Speech/Language Clinic – $50.00 (Difference
              of $65.00)

:
    Pediatric Patients:

    A basic comprehensive audiologic evaluation consists of the following CPT
    Codes and descriptors:

          Scenario #1:
           92557 Basic Comprehensive Audio (air and bone pure tone audiometry
                   and speech audiometry)
           92566 Immittance Audiometry (tympanometry and ipsilateral and
                   contralateral acoustic reflexes)
           92569 Acoustic Reflex Decay
           92587 Evoked OAE (limited otoacoustic emissions)

          Scenario #2:
           92555 Speech Recognition Threshold OR
           92556 Speech Audio: SRT & Word Recognition
           92566 Immittance Audiometry (tympanometry and ipsilateral and
                   contralateral acoustic reflexes)
           92582 Conditioned Play Audiometry
           92587 Evoked OAE (limited otoacoustic emissions)

          Scenario #3:
           92555 Speech Recognition Threshold
           92566 Immittance Audiometry (tympanometry and ipsilateral and
                   contralateral acoustic reflexes)
           92579 VRA Visual Reinforce Audiometry
           92587 Evoked OAE (limited otoacoustic emissions)


    Because this is a student training facility and procedures are done by Au.D.
    students all adult patients will be charged $115.00 rather than $265.00. The
    following exceptions will be made:

          Pediatric patients residing outside of Hillsborough County – $115.00
             (Difference of $0.00)




                                        12
             Pediatric patients residing within Hillsborough County – $50.00 (Difference
                of $65.00)

             Pediatric patients with Medicaid coverage – $10.00 (Difference of $105.00)

             Patients referred from USF Speech/Language Clinic – $50.00 (Difference
                 of $65.00)

             Patients referred as a result of USF screening – $50.00 (Difference of $65.00)

B. Hearing Aid Clinic

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

      Refer to “Hearing Aid Charges” (See forms for the USF Hearing Clinic) for
      various charges for hearing aid clinic. These will be placed in the respective
      rooms as follows:
             Hearing Aid Room #1 (PCD 1010) - the fee schedule will be
                     located inside the last cabinet door on the right.
             Hearing Aid Room #2 (PCD 1001) – the fee schedule will be
                     located inside the cabinet door above the sink.

      The following CPT Codes and descriptors are to be used when applicable:
             92590 Monaural HA (hearing aid) Examination
             92591 Binaural HA Examination
             92593 Hearing Aid Check
             92595 Hearing Aid Test
             92599 Otoscopy and Ear Impression
             V5059 Hearing Aid Dispensing Fee
             V5010 Hearing Aid(s)
             W5900 Earmold(s)

      New Hearing Aid Purchases

         As a general rule, total payment is due at the delivery of hearing aids.
         Patients will either pay the total at delivery or make a deposit at time of
         ordering with the balance due at delivery. On rare occasions, payment plans
         may be offered; these must be approved by the audiology clinic director. Fees
         are as follows:

             Total Hardware Cost - prices will depend the manufacturer, model, and
                                   type of hearing aid. Suggested pricing sheets are
                                   provided by manufacturers. Patients will be billed




                                           13
                      the listed single unit price for each hearing aid
                      purchased.

Total Accessories Cost – earmolds: Soft Shell/Lucite/Acrylic - $40.00
                                   JB 1000 - $50.00
                        Refer to the Hearing Aid Clinic Price List for
                                   other types of earmolds

Dispensing Fees - includes hearing evaluations and hearing aid checks
                  for length of warranty at no charge. Also included are a
                 package of batteries for each aid and a Dry & Store
                 Global

                                         Monaural             Binaural
             Basic Technology            $625.00                $975.00

             Intermediate Technology     $800.00              $1,400.00

             Advanced Technology         $950.00              $1,600.00

Follow-up visits

      Patients with hearing aids under warranty
            No charge for hearing evaluations and hearing aid checks
            for length of the warranty.

             Some supplies, such as wax guards, tubing changes, and
             minor repairs, are also provided at no charge during the
             warranty period.

             Major repairs are covered by manufacturer warranties and
             are also provided at no charge.

             Patient will be charged for all other accessories, supplies
             and products purchased.

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

Hearing Aid Repairs
      Fees associated with hearing aid repairs are collected when the
      patient is refit with the repaired aid(s).




                             14
C. Specialty Clinic - Cochlear Implant Clinic

      Fees generated in the cochlear implant program are billed primarily
      through USF Hearing and Balance Center, Dept. of Otolaryngology.
      Students will be required to complete (2) forms for fees. The USF superbill
      and the Dept. of Otolaryngology charge form. Dr. Muscato will assist the
      student when completing the Dept of Otolaryngology charge form as she must
      sign the form once it is completed. The audiology clinic superbill should be
      completed for services billed through Otolaryngology in the following manner:

            Fill in identifying information and diagnosis codes in the same
            manner as previously described.

            Under “Patient Type” on the bottom of the superbill, go to
            “Other” and fill in “CI PATIENT”

D. Specialty Clinic - Newborn Hearing Screening Clinic

      The patient is to be charged $50.00 if a resident of Hillsborough County or
      $115.00 if resides outside Hillsborough. The following CPT Codes and
      descriptors will be used:

            92587 Evoked OAE (limited otoacoustic emissions)
            92585 Auditory Brainstem Response

E. Specialty Clinic - Auditory Neuropathy/Auditory Dys-synchrony (AN/AD) Clinic

      The patient is to be charged $340.00 and the following CPT Codes and
      descriptors are to be used:

            92557 Basic Comprehensive Audio (air and bone pure tone
                   audiometry and speech audiometry)
            92566 Immittance Audiometry (tympanometry and ipsilateral and
                   contralateral acoustic reflexes)
            92569 Acoustic Reflex Decay
            92587 Evoked OAE (limited otoacoustic emissions)
            92585 Auditory Brainstem Response

      Additional services with CPT Codes and descriptors and charges:

            CI/HA SF testing - $50.00
            CI/HA Consult w/o programming - $60.00
            CI/HA Consult with programming - $110.00


F. Specialty Clinic - Auditory Processing (APD) Clinic



                                          15
        Initial Auditory processing disorders evaluation (APD)

               For the basic comprehensive audiological evaluation, the patient is to be
               charged:
                       $50.00 (referred from speech clinic or patient resides in
                             Hillsborough County) or
                      $115.00 (patient resides outside of Hillsborough County)

               Use the following CPT Codes and descriptors when performing the basic
               comprehensive audiological evaluation
    :
                      92557 Basic Comprehensive Audio (air and bone pure tone
                             audiometry and speech audiometry)
                      92566 Immittance Audiometry (tympanometry and ipsilateral and
                             contralateral acoustic reflexes)
                      92569 Acoustic Reflex Decay
                      92587 Evoked OAE (limited otoacoustic emissions)

               AND for the auditory processing disorders evaluation - $200.00 (includes
               testing, interpretation, & first half hour of consultation). Use the following
               CPT Codes and descriptors:

                      92589 Central Auditory Function Test

               If an ABR was also performed charge the patient $225.00 and use the
               following code and descriptor:

                      92585 Auditory Brainstem Response

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

        APD Consult – charge the patient each additional half hour - $50.00

        Off-campus consults – Portal to Portal (total time away from USF) – charge the
        patient $100.00 per hour

G. Specialty Clinic - Auditory Rehabilitation (AR) Clinic

        Fees are free for USF patients and VA patients. Patients referred from other
        places are billed $20.00 for 2 sessions of AR. Individual clients will be billed
        according to length of time enrolled.


        H. Specialty Clinic - Tinnitus Clinic - TBA




                                              16
VI. SUPERBILL

     A. General Information

           The USF superbill is the tracking form of charges for services provided. The
           superbill is completed on every scheduled and unscheduled patient seen in the
           USF Hearing Clinic whether or not payment is rendered.

           The audiology administrative assistant is responsible for all superbills as
           recommended by the USF Cash Collections Office. They are numerical and she
           must account for every superbill distributed and collected. She will distribute the
           forms. Therefore, all superbills must be returned to the assistant; these include
           those that are completed, those not completed, and those with errors. None of
           the superbills are to be thrown away. Students are not to begin filling out the
           superbill prior to the patient has arrived.

           The student completes this form on every patient seen in the clinic with the
           assistance of the clinic supervisor. ICD-9 code(s) will be checked off, CPT codes
           will be circled, and charges for services provided will be inserted in the
           appropriate places. As the superbill is in NCR form, students need to write firmly
           and avoid completing other forms on top of it. It is to be completed prior to
           escorting the patient to the checkout window.


    B. Procedures for completing the super bill for Adult Diagnostics:

           Complete the “date‟ services were provided
           Complete the “Patient‟s name”
           Check the appropriate “ICD – 9” code
           Circle the “CPT” code for the services provided – do not record actual fees
                   92557 - Basic Comprehensive Audio – this includes air, bone, &
                           speech (includes Quick SIN)
                   92566 - Immittance
                   92563 - Tone Decay Test
                   92587 - Evoked OAE (Limited)
                   92585- Auditory Brainstem Response Audiometry and fee of $225.00

           On the “CAE” line, the last line in the right hand column, write in “Adult” and enter
           the appropriate fees depending on the type of patient seen. Insert the following
           fees:
                 “General Patient”: $115.00
                 “USF Student”: $00.00
                 “USF Faculty/Staff”: $00.00
                 “HCC Student”: $15.00
                 “USF Faculty/Staff Family Member”: $50.00


                                                17
               “USF Referral": $50.00
               “Physical Plant”: $25.00
               “Comparative Medicine”: $ 95.00

        Enter amount under “Total Fees Today”

        Enter “Previous Amount Owed” if patient has a previous balance. This is
        determined by looking at the “Fee Statement” form located on the left
        hand side of the patient‟s file.

        Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
        Statement” form.

        The Supervisor will advise the student as to the completion of the “Amount
        Waived” when applicable.

        Calculate total amount and enter under “Total Due”

        Complete the “Patient Type” section located near the bottom center of the
        superbill. If need to go to “Other”, one of the following is to be written in
        depending on the type of patient seen:
              HCC Student
              USF Faculty Spouse
              Comparative Medicine
              Physical Plant
              USF Referral (referred by USF speech or hearing screening)
              Under warranty OR Not under warranty

        The Supervisor is to review the superbill and indicate approval by initialing in the
        top right hand corner of the superbill before the student escorts the patient to
        checkout.

        Audiology administrative assistant will complete the “Amount
        Paid”, “Balance” and “Payment Type”

        Attach the superbill to the outside of the patient‟s file and escort the
        patient to the audiology administrative assistant for checkout. Every patient goes
        to check out whether or not fees were charged.

C. Procedures for completing the super bill for Pediatric Diagnostics:

        Complete the “date” services were provided
        Complete the “Patient‟s name”
        Check the appropriate “ICD – 9” code
        Circle the “CPT” code for the services provided – do not record actual fees unless
        specified



                                             18
       92557 - Basic Comprehensive Audio – this includes air, bone, & speech
       92579 - VRA – pure tones only
       92582 - CPA – pure tones only
       92555 - SRT – for SDT or SRT only
       92556 - SRT/WR – this includes BKB-SIN & Quick SIN
       92566 - Immittance
       92563 - Tone Decay Test
       92587 - Evoked OAE (Limited)
       92585 - Auditory Brainstem Response Audiometry and $225.00

On the “CAE” line, the last line in the right hand column, write in
“Pediatric” and enter the appropriate fees depending on the type of
patient seen. Insert the following fees:

       Child resides outside of Hillsborough County: $115.00
       Child resides within Hillsborough County: $50.00
       Medicaid: $10.00
       USF Referral: $50.00

Enter amount under “Total Fees Today”

Enter “Previous Amount Owed” if patient has a previous balance. This is
determined by looking at the “Fee Statement” form located on the left
hand side of the patient‟s file.

Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
Statement” form.

Complete the “Patient Type” section located near the bottom center of the
superbill. If need to go to “Other”, one of the following is to be written in
depending on the type of patient seen:

   Pediatric HC
   Medicaid
   USF Referral (referred by USF speech or hearing screening)

The Supervisor will advise the student as to the completion of the “Amount
Waived” if this is applicable.

Calculate total amount and enter under “Total Due”

The Supervisor is to review the superbill and indicate approval by initialing in the
top right hand corner of the superbill before you take the patient to checkout.




                                     19
        Audiology administrative assistant will complete the “Amount Paid”,        “Balance”
        and “Payment Type”

        Attach the superbill to the outside of the patient‟s file and escort the
        patient to the audiology administrative assistant for checkout.



D. Procedures for completing the super bill for Other Clinics:

 APD (Auditory processing disorders):

        Complete the “date‟ services were provided
        Complete the “Patient‟s name”
        Check “ICD – 9” code for “CAP Disorder”
        Circle the “CPT” code for the services provided
                92557 - Basic Comprehensive Audio – this includes air, bone, & speech
                      (includes Quick SIN)
                92566 - Immittance
                92563 - Tone Decay Test
                92587 - Evoked OAE (Limited)
                92589 - Central Auditory Function Test and $200.00 for initial eval
                   OR $100.00 for re-eval.
                92585 - Auditory Brainstem Response Audiometry and $225.00

        On the “CAE” line, the last line in the right hand column, write in the
        “Pediatric” and enter the appropriate fees depending on the type of
        Patient seen. Insert the following fees:

               “General Patient”: $115.00
               “USF Referral": $50.00
               Pediatric HC: $50.00

        Total the fees incurred and enter the amount under “Total Fees Today”

        Enter “Previous Amount Owed” if patient has a previous balance. This is
        determined by looking at the “Fee Statement” form located on the left
        hand side of the patient‟s file.
        Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
        Statement” form.

        Complete the “Patient Type” section located near the bottom center of the
        superbill. If need to go to “Other”, one of the following is to be written in
        depending on the type of patient seen:




                                              20
            Pediatric HC – Hillsborough County resident
            USF Referral (referred by USF speech or hearing screening)
            AN/AD – Auditory Neuropathy/Auditory Dys-synchrony

     The Supervisor will advise the student as to the completion of the “Amount
     Waived” if this is applicable.

     Calculate total amount and enter under “Total Due”

     The Supervisor is to review the superbill and indicate approval by initialing in the
     top right hand corner of the superbill before you take the patient to checkout.

     Audiology administrative assistant will complete the “Amount Paid”, “Balance”
     and “Payment Type”

     Attach the superbill to the outside of the patient‟s file and escort the
     patient to the audiology administrative assistant for checkout.

Newborn Hearing Screening:

     Complete the “date‟ services were provided
     Complete the “Patient‟s name”
     Check the “ICD – 9” code for “Sensorineural Hearing Loss”
     Circle the “CPT” code for the services provided – do not record actual fees
             92587 - Evoked OAE (Limited)
             92585 - Auditory Brainstem Response Audiometry

     Enter amount under “Total Fees Today” – TBA

     Enter “Previous Amount Owed” if patient has a previous balance. This is
     determined by looking at the “Fee Statement” form located on the left
     hand side of the patient‟s file.

     Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
     Statement” form.

     Complete the “Patient Type” section located near the bottom center of the
     superbill. If need to go to “Other”, one of the following is to be written in
     depending on the type of patient seen:

        Pediatric HC
        USF Referral (referred by USF speech or hearing screening)
        Medicaid

     The Supervisor will advise the student as to the completion of the “Amount
     Waived” if this is applicable.



                                           21
      Calculate total amount and enter under “Total Due”

      The Supervisor is to review the superbill and indicate approval by initialing in the
      top right hand corner of the superbill before you take the patient to checkout.

      Audiology administrative assistant will complete the “Amount Paid”, “Balance”
      and “Payment Type”

      Attach the superbill to the outside of the patient‟s file and escort the
      patient to the audiology administrative assistant for checkout.

CI (Cochlear Implant):

      The “USF Superbill” should have been placed on the outside of the patient‟s
      file and students in CI clinic should add the superbill for CI clinic from Dept. of
      Otolaryngology to the file. This form is located in the hanging file of forms in the
      CI programming room.

      FOR THE USF SUPERBILL:

             Complete the “date‟ services were provided
             Complete the “Patient‟s name”
             Check “ICD – 9” code for “Sensorineural Hearing Loss”

             DO NOT fill in the CPT codes on this form.
             Go to the bottom center of the page under “Patient Type” to “OTHER”
             Write in : CI patient

Hearing Aid Clinic:

      Complete the “date‟ services were provided
      Complete the “Patient‟s name”
      Check “ICD – 9” code for type of hearing loss patient presents
      Circle the “CPT” code for the services provided where applicable or record services
      provided and/or products purchased and charges. Refer to USF Hearing Aid Clinic
      Price List and manufacturers suggested pricing sheets as needed.
      Total the fees incurred and enter the amount under “Total Fees Today”

      Enter “Previous Amount Owed” if patient has a previous balance. This is
      determined by looking at the “Fee Statement” form located on the left
      hand side of the patient‟s file.

      Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
      Statement” form.




                                            22
      Complete the “Patient Type” section located near the bottom center of the
      superbill. If need to go to “Other”, one of the following is to be written in
      depending on the type of patient seen:

             New HA
             Under warranty, not under warranty

      The Supervisor will advise the student as to the completion of the “Amount
      Waived” if this is applicable.

      Calculate total amount and enter under “Total Due”

      The Supervisor is to review the superbill and indicate approval by initialing in the
      top right hand corner of the superbill before you take the patient to checkout.

      Administrative staff will complete the “Amount Paid”, “Balance” and
      “Payment Type”

      Attach the superbill to the outside of the patient‟s file and escort the
      patient to the audiology administrative assistant for checkout.


Auditory Rehabilitation Clinic (AR)

      Complete the “date” completing the superbill. A superbill is only completed
      on the initial day of treatment indicating beginning and ending dates and
      if the patient is making payments.
      Complete the “Patient‟s name”
      Check the appropriate “ICD – 9” code
              For APD treatment, check 389.14 CAP Disorder
              For other types of AR, check code related to type of patient‟s hearing loss
      Insert CPT – Code

             92507 Treatment of speech, language, voice, communication, and/or
                    auditory processing; individual
             92508 Treatment of speech, language, voice, communication, and/or
                    auditory processing; group, two or more individuals
             92626 Evaluation of auditory rehabilitation status, 1st hour
             92627 Evaluation of auditory rehabilitation status, each additional 15 minutes
             92630 Auditory rehabilitation; pre-lingual hearing loss
             92633 Auditory rehabilitation; post-lingual hearing loss
                   Insert charge of $20.00 for the 2 sessions if group and include
                   beginning and ending dates of the treatment session.

      Total the fees incurred and enter the amount under “Total Fees Today”




                                            23
Enter “Previous Amount Owed” if patient has a previous balance. This is
determined by looking at the “Fee Statement” form located on the left
hand side of the patient‟s file.

Enter “Previous Credit Balance” if this is indicated by looking at the “Fee
Statement” form.

Complete the “Patient Type” section located near the bottom center of the
superbill. If need to go to “Other”, one of the following is to be written in
depending on the type of patient seen:
      Pediatric HC
      USF Referral (referred by USF speech or hearing screening)

The Supervisor will advise the student as to the completion of the “Amount
Waived” if this is applicable.

Calculate total amount and enter under “Total Due”

The Supervisor is to review the superbill and indicate approval by initialing in the
top right hand corner of the superbill before you take the patient to checkout.

Administrative staff will complete the “Amount Paid”, “Balance” and
“Payment Type”

Attach the superbill to the outside of the patient‟s file and escort the
patient to the audiology administrative assistant for checkout.




                                      24
VII. COLLECTION OF FEES

     The audiology clinic administrative assistant upon completion of the patient‟s
     appointment will collect fees as designated on the superbill.

     NOTE: At this point in time the only staff/faculty members of the CSD Department
     allowed to collect fees are the audiology administrative assistant, the speech
     administrative assistant, and Dr. Zelski as recommended by the USF Cash Collections
     Office. If the audiology administrative assistant is not available consult your clinical
     supervisor.

     Upon receipt of the superbill, the audiology administrative assistant completes the
     “Amount Paid”, “Balance”, and “Payment Type” portions of the superbill.

     The audiology administrative assistant then collects the fees in either the form of cash,
     check, or credit card as follows:

            Cash – attach the tender to the “yellow” copy of the superbill via paper clip and
                   place in the locked box.

            Check – the check will be endorsed with the required stamp
                    the check number will be written on the superbill
                    the check will be attached to the “yellow” copy of the superbill via
                   paper clip and placed in the locked box

            Credit card – the patient‟s credit card will be swiped
                          two copies of the receipt will be obtained from the credit card machine
                               - Patient signs one copy and this is attached to the “yellow
                                   copy” of the super bill via paper clip to be placed in the
                                   locked box
                               - The other receipt copy is stapled to the “pink” copy of the
                                   superbill

          Note: If no fees are collected, it is noted on the superbill and the “yellow” copy is
          placed in the lock box.

     Distribution of the “white” and “pink” copies of the superbill
           “white” – is placed in the patient‟s file
           “pink” – is given to the patient as their receipt

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




                                                  25
VIII. Clinic Equipment

   A. Available Equipment

      Audiology Suites

              Audiology clinic has four formal audiologic test areas with sound treated booths.
              Each room is equipped with a diagnostic audiometer, cassette tape deck and/or
              compact disc player, headphones, insert phones, bone oscillator, and soundfield
              system. Due to variations in equipment and physical arrangements with the test
              suites, certain rooms may be better equipped to service a particular patient
              (adult, pediatric, hearing aid, cochlear implant, wheelchairs, etc.).

              Reminder: Students should use Audiology Suites A and D for pediatric patients
              and B and C for adult patients. Individual supervisors will assign these suites to
              students on a rotating basis.

      Foyer

              The foyer (the entry area to the four test rooms) houses the video-otoscopes, the
              middle ear analyzers, the ultrasonic cleaner, and forms. The Med Rx video-
              otoscope system is to be used under direct supervision only.

      Hearing Aid Clinic

              Hearing aid clinic – PCD 1001 and 1010 are designated for hearing aid
              evaluations, fittings, and repairs. PCD 1010 is considered the primary fitting
              room with PCD 1001 as secondary. Hearing aid supplies, earmold impressions
              materials, hearing aid forms, programming and electro-acoustic analysis
              equipment, and more are available.

      Pediatric Diagnostics/Pediatric Audiology Suites/CI Clinic

              Toys:

                      Toys are stored in the designated cabinets in the foyer. These are the first
                      two cabinets located on the right side of the foyer and the first cabinet on
                      the left side. Toys are to be kept in these cabinets when not in use and not
                      to be kept in the audiology suites. Please keep these cabinets neat and
                      organized. If necessary disinfect before storing.




                                                    26
      MLV screen:

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

      Room preparation:

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

             For VRA, preparation for your patient may include the following:

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

             For CPA, preparation for your patient may include the following:

                    Selection of toys for use as reinforcers
                    Inserting patient information on the ILOv6 system
                    If using the portable audiometer, setting it up and arranging the
                    chairs If using the main audiometer, setting up the chair for the
                            patient/parent/guardian, moving the table to the side to make
                            room for the assistant‟s chair, setting up the FM system
                            (located in Suite A) for Suite A or plugging in the assistant‟s
                            monitoring headset for Suite D.

CI Clinic

      Students assigned to CI practicum will be meeting with Dr. Muscato prior to
      clinic starting for orientation. However, students should plan on preparing an
      Audiological test suite for each session based on the age of the patient.

      Speakers need to be checked as part of the biological check and computers in
      room 1005 should be turned on and logged on. At the end of each session,
      THESE COMPUTERS are to be TURNED OFF, unlike the other computers in
      the audiology clinic.

      Dr. Muscato has separate “TEST TOYS” and “play toys” for pediatric CI
      patients in room 1005. If you take toys from the Audiological test suite area,



                                           27
      be sure to return them to the proper location at the end of the session. A high
      chair can be found in the conference room for toddlers needing CI programming
      and for infants, the high chair in suite A is usually available.

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

Audiological Rehabilitation

      Students assigned to audiological rehabilitation (AR) are required to prepare the
      computer and materials prior to patients arriving.

      PCD 1006 is designated for AR sessions. At the conclusion of the session,
      equipment should be turned off and stored away. The locked cabinet has a key
      lock and needs to be locked at the end of each session.

      PCD 1006 also houses the assistive listening devices cart.




                                           28
  Conference Room

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

B. Operation of Equipment

  Student Practice

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

  Sign-out of equipment and manuals

        Equipment manuals are available for student use; these are located on the
        shelving unit in the foyer and may be checked out on an overnight basis. In order
        to check out equipment and/or manuals, first obtain the approval of a supervisor.
        Then, fill out the “Equipment/Manual Sign-out Sheet” (See forms for USF
        Hearing Clinic) located in a folder on the shelving unit.

        Use the same procedure to check out materials in the storage room, but
        complete the checkout form located there.

        All equipment and/or manuals are to be returned the next morning by 8:30am.

  Expected student performance

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

  Equipment Start-Up

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

        Morning Clinic

               Student clinicians assigned to morning clinic are required to arrive 30
               minutes before their scheduled block of time to prepare clinic rooms, turn



                                             29
      on equipment and computers, and to complete the biological listening
      checks of the equipment.

      The equipment to be powered up may include the audiometers, CD
      players, immittance equipment, OAE equipment, and computers.
      Biological checks will need to be performed on the audiometers,
      immittance equipment, and OAE devices. See procedures below for
      calibration of equipment. Once the checks have been completed, the
      equipment is to be left on for the day; unless specified by the clinic
      supervisor. (Note: Capella OAE must be turned on prior to opening the
      NOAH module)

      In addition, all computers should be restarted. On Monday morning the
      computers should be fully shut down and then turned on again. On other
      days, they should be restarted. After rebooting, students should log each
      computer on to the audclinic network.

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

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

Afternoon Clinic

      Students assigned to afternoon clinics are to arrive 30 minutes prior
      to the scheduled start time.

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

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

How much equipment to start-up?

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

      Remember to follow the procedures as described above in morning clinic
      start-up. These checks are to be completed for equipment in each
      audiology suite needed for the day.




                                   30
             If no one is scheduled at least one adult and one pediatric audiology suite
             must be prepared to accommodate walk-ins or retests via hearing aid
             clinic and cochlear implant clinic.

      Hearing Aid Clinic

             Students are to assist in the calibration of equipment when needed for
             diagnostic clinic. They are also responsible for preparing materials, the
             room and/or equipment needed for scheduled hearing aid patients.

      Cochlear Implant Clinic

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

      Audiological Rehabilitation/APD Treatment Clinic

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

Daily Biological Calibration Check

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

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

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




                                             31
Equipment Shut-Down

     Students assigned to the last evaluation of the day are responsible for turning off
     all equipment, even if no one was scheduled.

     Clean, rinse, and put out to dry items placed in the ultrasonic cleaners (Wavicide
     with 2 % glutaraldehyde). Start cycle and remove tips when the cycle is
     completed. Rinse the ear tips in cool water and place on a paper towel to dry.
     The Wavicide solution is changed every 30 days or sooner, and the current date
     is posted on the ultra-sonic cleaner.

     All computers are logged off but left on.

     All clinical equipment except power amplifiers should be turned off.

     For students with morning clinic slots, if no patients are scheduled for an
     afternoon, the students should check with their supervisor to determine if any or
     all equipment should be turned off.

     At the end of each Thursday clinic, the batteries from each otoscope must be
     plugged in for charging over the weekend.

 Monthly Biological Calibration Listening Check

     A designated supervisor will assign teams of students each month to complete
     monthly biological calibration listening checks of the audiometers during the last
     week of each month. You will be notified at the beginning of each semester
     regarding this assignment.

     Perform the listening check as stated in “Monthly Biological Calibration Check
     Procedures” (See forms for USF Hearing Clinic.)

     After performing the listening check, complete and initial the “Audiology
     Monthly Biological Listening Check List” (See forms for USF Hearing Clinic)
     found in the notebook located next to the audiometer in each suite.

     Inform the designated supervisor when these checks are completed.

     The student is to record any problems in the log, complete an “Equipment
     Incidence Report Form,” (See forms for USF Hearing Clinic) and turn in the
     report immediately to the supervisor.




                                          32
IX. Patient Files

      Confidentiality

             All parts of a patient‟s file are considered confidential. Files and any parts of the
             file may be taken to the first or second floor student workroom. They may not
             under any circumstances be removed from the building. A student found
             removing files (or any portion of a file that identifies the patient) from the
             building may be subject to dismissal from the program.

             Copies of previous reports, audiograms, case history forms, and other
             documents needed for report writing, case presentation, or coursework are not to
             be copied nor be removed from the clinic without approval from a clinic
             supervisor.

             A copy of the current audiogram may be provided to the student clinician by
             the supervisor with identifying information removed.

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

                    The student is responsible for removing all of the patient‟s personal
                    identification such as name, file #, social security #, address, and phone #
                    from all copies. Information such as age, date of birth, gender, and city of
                    residence may be left on forms that are copied.

                    Before copies leave the department, the supervisor must review them.

             Please do not leave patient files unattended. As you move from room to room
             bring the file with you. Under no circumstances are files to be left in a room
             with a patient unless the student or supervisor is present. Patients do have the
             right to look at their files, but the student clinician and/or supervisor should be
             with the patient.

      New Patient Files

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

                    “Record of Reports & Letters Sent Log”
                    “Patient Fee Statement”
                    “Intake Form/USF Audiology Clinic”




                                                   33
      The audiology clinic administrative assistant will record the patient‟s name in
      pencil on the outside of the file.

File Organization

      Patient files are organized as needed into six sections on colored backings
      (located in the audiology student workroom). The student is to organize patient
      folders as follows:

                Yellow backing – FM notes, invoices, and all forms related to FM
                Pink backing – Cochlear implant Pre-evaluation. This includes ALL test
                      forms, correspondence and audiometric data used in consideration
                      of candidacy. There is a cover page located in the CI room (1005)
                      in the hanging file.
                Red backing – Audiograms and associated reports, immittance strips,
                      OAE data sheets. This includes audiograms and reports from other
                      agencies.
                Green backing – Hearing aid notes, invoices, and all forms related to
                      hearing aids. Hearing aid summary forms will be placed on the top
                      of this packet.
                      Green backing (CI) – All programming notes and equipment forms
                      for cochlear implant and speech processors is kept here.
                Peach backing – Includes parent inquires, letters for parents other than
                      evaluation and all other information from other agencies including
                      medical updates.
                Blue backing – case history, case history updates, and release forms.

      All reports and other materials are filed in chronological order from the oldest
      (on bottom) to most current (on top) on each backing.

      The organizational sections and colors of the backings are in order from top to
      bottom.

      Punch holes as needed in all papers and organize appropriately after each
      patient is seen.

Patient Files

      File locations:

                Patient file folders will be located in the lateral filing cabinet located in
                PCD 1017 under “scheduled for evaluation (SFE)” or “reports in progress
                (RIP).”




                                               34
             Patient file folders may also be found in the hearing aid/cochlear
             implant/auditory processing disorders (HA/CI/APD) filing cabinet
             located in PCD 1017.

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

      Student clinicians may pull files from the filing cabinets, but may not re-file files.
      Files being returned must be placed in the “re-filing bin” located on the table
      opposite the filing cabinet in PCD 1017. All files must have a completed routing
      slip attached to the outside of the file.

      Patient files must be returned to the “re-filing bin” by the end of each day no later
      than 5:00. Students are not to keep patient files overnight in the student file box
      located in the audiology student workroom. Remember to attach a completed
      routing slip.

      During the day, students may keep files in the student file box in the student
      workroom. Please remember to return to the “re-filing bin” by the end of the day.

      Files on the day of a patient‟s appointment may be picked up from the “wall hot
      files” located above the “re-filing bin”. These files must be returned to the
      audiology clinic administrative assistant prior to the patient‟s arrival for check-in
      purposes. This enables the audiology clinic administrative assistant to efficiently
      “check-in” the patient upon their arrival.


Patient File Review

      If a patient has been previously seen in the clinic, it is the responsibility of the
      student clinician to read the file and become familiar with the case. Likewise, if a
      patient is new to the clinic, the student clinician must review the Intake Form to
      determine the type of appointment, referral source, etc. All files must be returned
      to the “re-filing bin” upon completion of review.

USF Students

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

      A file is created if any abnormal findings are present. On the routing slip indicate
      “please create a file.”



                                             35
If services were provided for a student is from the music department, the
audiology administrative assistant will staple information together and place in a
file labeled “Music Department.”

If the services were provided for a hearing conservation program, the audiology
administrative assistant will maintain individual records as part of that group.




                                     36
X. The Appointment

     Patient Check-in

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

           A case history form will be given to all new patients. The case history form is
           completed on the patient‟s first visit to the clinic and updated on subsequent
           visits.

           For returning patients, the audiology clinic administrative assistant will verify that
           address, phone number, etc. is correct.

           Once the case history form is completed or identifying information updated, the
           audiology clinic administrative assistant will place the file in the assigned clinic
           supervisor‟s hot file located in PCD 1017.

           The audiology clinic administrative assistant will direct the patient to the waiting
           area.

           It will be the responsibility of the student to check on their patient‟s arrival at the
           audiology clinic administrative assistant‟s window, to obtain the file, inform the
           supervisor of the patient‟s arrival, and greet their patients in a timely manner.

           The student will mark out the patient‟s name on the sign in sheet with a black pen
           so that the patient‟s name is eligible.

     Case History/Updates

           Case History Forms

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

              The “Pediatric CI Case History Form for Children” is given to children who
                 are potential CI candidates or already have CI.

              The adult case history form, “Audiology Case History Form for Adults,”
                 (See forms for USF Hearing Clinic) will be given to all remaining patients.

              The “Supplemental CI Case History Form for Adults” is also given to
                 adults with existing CIs.



                                                  37
             The “Supplemental APD Case History Form” is given to patients when
             APD evaluations have been scheduled.

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

      Case History Update

             The student clinician is responsible for updating medical, audiological, and
             other information from subsequent patient visits to the USF clinic on the
             “Case History Update” form (See forms for USF Hearing Clinic).

             Phones calls are also recorded here.

      Hearing Aid Notes

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

             Information obtained from phone calls are also recorded here.

             Information regarding hearing aids sent in for repairs, returned from
             repairs, exchanges, and etc are recorded on this form.

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

      CI Notes

             Used to record information; these are located in the CI room. These are
             for equipment and visit notes. Information obtained from phone calls are
             also recorded here. Information regarding speech processors sent in for
             repairs, returned from repairs, etc are recorded on this form. Please
             record model and serial numbers each time a reference is made to the
             patient‟s speech processor. This is so important for the tracking purposes.
             SOAP notes are not written here, a separate report will be written

Interview

      Students are to greet their patients in the waiting area and direct them to the
      conference room, foyer, or other available room for the patient interview.




                                           38
      It is the responsibility of the student to verify the purpose of the visit with the
      patient and to then conduct the interview to obtain needed information. The
      student is to record information obtained on the case history form for new
      patients and case history or hearing aid notes form for returning patients.

      NOTE: if interviewing in the foyer, make sure other patients are not around.
      Remember patient confidentiality.

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

Type of Appointment

NOTE: Procedures for each stated below have been addressed in previous coursework,
but the student clinician is to discuss these with the supervisor. The test battery or
procedure chosen may consist of any of the above and may vary in sequence
depending on the individual needs of the patient.

      Audiological Evaluation
         Otoscopy
         Immittance
            1. Screen
            2. Diagnostic
               a. Ear canal volume, static compliance, middle ear pressure, gradient
               b. Ipsilateral acoustic reflexes @ 1000 Hz, from time to time other
                   frequencies may be added.
               c. Contralateral acoustic reflexes @ 500 Hz, 1000 Hz, and 2000 Hz
               d. Tympanometry for infants less than 4-5 months of age need to be
                   tested using the 1000 Hz probe tone
         Acoustic Reflex Decay @ 500 Hz and 1000 Hz
         Pure-tone Audiometry
            1. Air Conduction– phones, insert receivers, soundfield
            2. Bone Conduction
         Speech Audiometry
            1. Speech Detection Threshold
            2. Speech Recognition Threshold
            3. Word Recognition (WRS) or alternative as directed by the supervisor


                                             39
       Special Tests
        1. Olsen-Noffsinger Tone Decay Test
        2. PI-PB Function
        3. Stenger (Pure-tone, Speech)
        4. Other
       Electrophysiological Tests
        1. ECoG
        2. ABR
        3. MLR
        4. LLR
        5. P300
        6. Other
       Otoacoustic Emission (OAE)
        1. Distortion Product (DPOAE)
        2. Transient Evoked (TEOAE); note in exceptional cases only perform TEs
       Most Comfortable Level/Uncomfortable Level (MCL/UCL) – tones and/or
        speech
       Other

Hearing Aid Clinic
   Hearing Aid Evaluation
   Hearing Aid Consult
   Hearing Aid Fitting
      Verification and Validation
   Hearing Aid Follow Up
      Verification and Validation
   Hearing Aid Repair
   Other

Cochlear Implant Clinic
   Candidacy
   Mapping/Programming
   Troubleshooting/Repair
   Counseling/Therapy

Auditory Processing Battery

Aural Rehabilitation Therapy/Auditory Processing Disorders Treatment

Other




                                    40
Test Protocols

      Adult Diagnostics for patients obtaining first or new hearing aids:
        Otoscopy
        Immittance
        Acoustic reflex decay
        OAEs
        Pure tone audiometry – include 3000 and 6000 Hz for AC testing
        SRTs,
        Quick Sin in the monaural and binaural test conditions
        MCL and UCL using speech stimuli.

      Adult Diagnostics for patients with existing hearing loss but not obtaining
      hearing aids:
         Otoscopy
         Immittance
         Acoustic reflex decay
         OAEs
         Pure tone audiometry – include 3000 and 6000 Hz for AC testing
         SRTs,
         Quick Sin in the monaural and binaural test conditions

      Adult Diagnostics for patients with normal hearing and no listening
      concerns:
         Otoscopy
         Immittance
         Acoustic reflex decay
         OAEs
         Pure tone audiometry – include 3000 and 6000 Hz for AC testing
         SRTs,
         NU-6 ordered by difficulty word list

      Adult Diagnostics for patients with normal hearing and reported
      listening concerns:
          Otoscopy
          Immittance
          Acoustic reflex decay
          OAEs
          Pure tone audiometry – include 3000 and 6000 Hz
          SRTs,
          Quick Sin in the monaural and binaural test conditions

      Physical Plant/Comparative Medicine
       Base Line evaluation
            Use standard adult evaluation protocols
            Test high frequencies by pure tone (above 8 kHz)



                                        41
 Annual evaluation
     Otoscopy
     OAEs
     Pure tone air thresholds to include high frequencies

New Hearing Aid Fittings

      At the time of the dispensing of the hearing aid(s), the patient will be
      scheduled for the 2 week and 30 day follow up appointments.

      At the 2 week follow up appointment the following may occur:
             Hearing aid adjustments as needed
             Discuss use and benefits of hearing aids
             The patient will be given a Dry „n Store
             Review the COSI
             Introduction to the LACE Program

      At the 30 day follow up appointment the following may occur:
             Hearing aid adjustments as needed
             Finalize the COSI
             A segment of the LACE Program
             Other LACE sessions will be scheduled as needed through the AR
                    program

Children ages 5 to 21 years old
      Otoscopy
      Immittance
      Acoustic reflex decay – 12 yo +
      OAEs
      Pure tone audiometry – include 3000 and 6000 Hz for AC testing if
                              presents with a SNHL
      SRTs,
      BKB-Sin in the monaural and binaural test conditions – 5 to 14 yo
      Quick Sin in the monaural and binaural test conditions - 14 yo +

Pediatrics, 6 months through 4 years of age
      Otoscopy
      Tympanometry – use the 1000 Hz probe tone for 6 through 7 months of age
      Acoustic Reflexes – ipsilateral for 1000 Hz and contralateral at 500, 1000, and
                          2000 Hz
      TEOAEs and DPOAEs
      Pure tone audiometry – 500 through 4000 Hz
      SDT or SRT
      VRA – 6 months through 2 years of age
      CPA – 3 through 4 years of age




                                     42
  Cochlear Implant

         Candidacy Evaluation- see pre-evaluation forms for adult and child in
         room 2005
         Initial Activation
         Follow-up Programming
         Counseling – Pre and Post

  **** Protocols are discussed in the Orientation meeting for specialty clinic.

  Newborns, birth to 4 months
         NOTE: As the baby approaches 4 months of age, there is a good chance that
  the baby will need to be referred to a facility that performs sedated ABRs. The USF
  audiology clinic is not set up to perform sedated ABRs as suggested by the Pediatric
  Sedation Guidelines.

     Screening
        TEOAEs and DPOAEs
        Auditory Brainstem Response Screen at 30 dB nHL and at 90 dB
               nHL to rule out AN/AD, condensation and rarefaction runs, repeat
               in polarity with best morphology

     Diagnostic Evaluation
        Tympanometry using the 1000 Hz probe tone
        Acoustic Reflexes – ipsilateral and contralateral (attempt 1000 Hz first in
               both test modes)
        Auditory Brainstem Response study – latency/intensity function and at 90
                dB nHL to rule out AN/AD, condensation and rarefaction
                runs, repeat in polarity with best morphology

Counseling

  When all test data has been collected for students in diagnostic clinic, the patient
  is directed to an available interview room or the patient waiting area.

  The student clinician discusses the results and recommendations with the
  supervisor. If time permits, the student will write the SOAP notes and the
  supervisor will review and sign the audiogram.

  The student clinician and the supervisor will then discuss information to be
  presented to the patient. Students are to counsel the patient as discussed
  with the supervisor. The student is to avoid presenting new information that
  wasn‟t discussed previously with the supervisor. If additional thoughts occurred
  to the student during the conference with the patient, the student is to request
  that the supervisor step out of the room with the student for a consult.




                                       43
  The student is to keep in mind that the supervisor may at times interrupt, in a
  professional manner, to present information in another way, make corrections, or
  provide additional information as it arises. These are to be taken as teaching
  tools used by the supervisor for the student.

Wrap Up

  The student and the supervisor will determine the charges incurred for services
  received and complete the superbill. This is to be attached to the outside of the
  patient‟s file.

  Whenever possible, attempt to complete the audiogram so that a copy may be
  given to the patient before leaving their appointment.

  There may be times in which SOAP notes will not be written prior to
  counseling the patient due to time constraints. In these cases, SOAP notes
  will be written at some time after the appointment and reviewed and signed by
  the supervisor. Unless specifically excused by the supervisor SOAP notes
  should be completed on the day of the appointment.

  The student is to complete the routing slip; this is to be attached to the outside of
  the patient‟s file.

  The student is to check that the patient has signed the release to receive or send
  documents forms. If these are not signed reports or any other information may
  not be sent or requested by the USF Audiology Clinic.

Patient Check Out

  At the completion of the appointment, the student will accompany the patient
  to the audiology clinic administrative assistant‟s window for “check out.”

  The student will provide the audiology clinic administrative assistant with the
  patient‟s file, completed superbill, and routing slip.

  Billing for CI clinic – check with Dr. Muscato.

  At this time the audiology clinic administrative assistant will:
          Collect fees and provide the patient with the pink copy of the superbill

          Schedule needed return appointments
          Make copies of the completed audiogram or hearing aid information for
          the patient when applicable.

          Will enter the date of evaluation, type of services rendered, amount due,
          amount paid on the “Patient Fee Statement” form.



                                        44
Time permitting, all patients are provided with a finished copy of the audiogram. If
the audiogram summary is not completed within the time allotted for the session,
the audiology clinic administrative assistant may mail the completed audiogram
to the patient or hold it for patient to pickup at a later date.

The audiology clinic administrative assistant will record the date, type of
correspondence (audio, report), and recipient on the “Correspondences Sent
Log” form. Examples:

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

The file will then be placed in the location as specified by the student on the
routing slip




                                     45
XI. After the Appointment

      File/Routing Slip

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

                   The “return to the student” line should be checked if items in the file
                   folder are incomplete, in need of signatures, and/or need to be organized,
                   it will be placed the “reports in progress file” by the audiology clinic
                   administrative assistant. The file folder will remain there until the student
                   picks it up for completion.

                   The “return to the supervisor” line should be checked if the supervisor
                   needs to review the file and/or signatures are needed. Then it will be
                   placed in the respective supervisor‟s mailbox.

                   The “place in reports in progress” line should be checked if the file is
                   organized, file items are completed, file has been reviewed by the
                   supervisor and signatures are obtained, it will be placed in the “reports in
                   progress” file by the audiology clinic administrative assistant awaiting
                   completion of the report.

            It is in the student‟s best interest to have the file in order before leaving clinic for
            the day.

            All file folders must be returned to the “re-filing bin” by the end of the day, no later
            than 5 p.m. No file folders are to be kept outside the clinic office, including the
            student file box located in the student workroom overnight. The student must turn
            them in with a completed routing slip.

      Infection Control/Room Cleaning

            All clinicians should wash their hands before and after handling patients.

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

            Student clinicians are responsible for keeping the test rooms in order.

            After each patient, student clinicians are expected to perform infection control
            and to record that this task has been done



                                                    46
            Cavicide, Sani-cloths, glutaraldehyde, paper towels, and protective gloves
            are provided for use in sanitation.

            All surfaces, including headphones, eartips, chairs, tables, and door
            handles must be disinfected to discourage the spread of infectious
            disease
            On smooth surfaces such as tables:

                   First spray Cavicide on surface
                   With a gloved hand, wipe surface with a paper towel.
                   Then, spray the surface again and allow it to air dry.
                   Do not spray Cavicide on soft surfaces such as cushioned chair
                       seats.

            For items such as headphones, wipe with a Sani-cloth (NOTE: do not use
            these cleansers on the high frequency headphones).
            .
            Record the date, time, and your initials on the infection control page of
            the appropriate notebook.

            In addition all materials must be put away, checked, and supplies
            replenished. If materials and supplies are in need of replenishment consult
            the clinic supervisor.

Logging Clinical Experience

      Each student clinician is responsible for recording on a daily basis the types of
      services and related activities completed during their assigned blocks of clinical
      practica on the “Audiology Clinical Experience Tracking Form” (See forms for
      USF hearing clinic). See forms for USF hearing clinic for examples of “related
      activities”.

      In order for the student clinician to receive credit for clock hours, the student
      clinician must obtain the supervisor‟s signature at the end of each assigned block
      of time.

      If the student clinician‟s performance was unacceptable during a scheduled block
      of time, the supervisor will not sign off on those hours.

Yellow ASHA Hour Sheets

      Each audiology clinic student must transfer the hours completed from the
      Audiology Clinical Tracking Form to the yellow ASHA hour sheets at the end of
      each semester of clinic.




                                          47
   The student is to complete two “originals” of each form. These blank forms
   may be obtained from the audiology administrative assistant or from the file box
   in the audiology student workroom.

   Complete the following neatly and legibly in ink on each form, a sample is
   provided in the student workroom:

      Supervisor‟s first, middle initial and last name
      Supervisor‟s CCC area – i.e., Aud or SLP
      Site of clinic assignment – i.e., USF (1st yr); USF (2nd yr); VA, St. Josephs,
      AIB (3rd yr)
      Date clinic ended
      Hours – insert hours bring down totals to the side and bottom of each section,
          round up to the nearest ¼ hour (i.e. .25, .5, .75)

Complete a separate form for supervisors other than Dr.s Carr, Muscato,
Richardson, and Zelski. Under each section, insert no more than two supervisors.
When inserting two supervisors under a section, skip a line. This will allow space for
supervisor signatures under their name.

Forms will not be accepted with cross outs

Incomplete and incorrectly completed forms will be returned to the student

Upon completion of the forms:
      o Submit forms for Drs Carr, Patterson, Richardson, and Zelski to Dr. Carr.
        Once signatures are obtained both originals will be returned to the
        student.
      o Obtain signatures on both originals for all other supervisors.
 Once signatures have been obtained the student must submit one original to
  the audiology clinic assistant and retain the other original for safe keeping
 Deadline for submission will be announced at the beginning of each semester




                                        48
Patient Reminder Call Back File

      A call back card will be completed by the student clinician if it has been
      recommended that the patient return for further testing or retest within the next
      12 months with the patient‟s approval.

      The blank cards will be placed in the foyer and the student workroom.
      The student clinician records the patient‟s name, phone number, and type of
      appointment on a 3X5 index card and attaches it to outside of the patient‟s file for
      the audiology clinic administrative assistant to place in the patient reminder call
      back file box.




                                           49
XII. Patient Reports

      Sensitive Material:
             Care must be taken when writing reports. Sensitive information will include but
             will not be limited to the following areas:

                    Information that could be considered social in nature with an attached
                    social stigma, to include family history of mental illness, substance abuse,
                    suicide or suicidal intent; marital discord or marital problems

                    Information about the behavior or personality of another family member
                    not provided by that person (e.g., mother describing her ex-husband as
                    violent or abusive.

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

             Financial information should almost always be excluded from a report unless it is
             directly relevant to the diagnosis (e.g., financial problems causing the parents to
             be unable to obtain medical care).

      A formal written report is required for each patient new to the USF Hearing Clinic and
      includes:
             Patients seen for AP testing
             Patients seen for electrophysiological testing
             USF students diagnosed with hearing loss
             Pre-evaluation CI candidacy and initial CI activation
             Other reports may be requested at the discretion of the clinic supervisor.

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

      Reports are not needed for USF students scheduled for a hearing evaluation to fulfill a
      class requirement unless results are abnormal on any test.

      Once it has been determined the type of report to be written:

             The student clinician is to submit the initial typewritten, double-spaced report.

             This report is due to the supervisor within 48 hours of the evaluation.

             Rewrites are due to the supervisor within 24 hours. Include all drafts with
             rewrites.




                                                  50
       Report templates will be available on Blackboard and on the computers in the
       clinic.


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

Reports are not to be left on the hard drive when using clinic computers. If reports are
found on the places other than under the designated “student reports” file, they will be
deleted.


In addition to the electronic submission of reports on the “audclinic” network, individual
supervisors have other requests for submission of reports, these are as follows:

       Dr. Carr – indicate on bottom of routing slip that “report is on the “I” drive”
             and place the patient‟s file in her mailbox located in PCD 1017.

       Dr. Muscato - indicate on bottom of routing slip that “report is on the “I” drive” ,
             send email that you have completed the report, and place the patient‟s file
             in her mailbox located in PCD 1017.

       Dr. Richardson would also like the report sent to her via email;
              remember to omit identifying info

       Dr. Zelski would also like the report sent to him via email;
               remember to omit identifying info

Reports written in clinic:

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

       The student clinician may use available computers located in the clinic.
       Computers are also available in the student workroom on the second floor.


                                              51
       The report may be reviewed with the supervisor during the scheduled block, time
       permitting.

       Patient identifying information may be included in the report.

Reports written outside of clinic:

       Reports may be written at home but you must insert them into the “audclinic”
       network via flash drive. Remember to omit identifying info.

       Must have identifying information omitted. This includes the patient‟s name, date
       of birth, address, social security number, phone number, and file number.

       Anonymous codes generated by the student will be used in place of the patient‟s
       name and other names throughout report. These code names must be entered in
       the report using a colored font of the student‟s choice.

Once the supervisor has approved that the draft is ready for the final report the student
clinician does the following:

       Completes all identifying information
       Changes to single-space format
       Signs the report
       Returns the report to the supervisor attached to the patient‟s file with all drafts.

Until the file is complete, the file will be kept in the reports in progress file drawer in PCD
1017. These procedures are put in place for legal purposes, the preservation of our
patients‟ confidentiality, and for the protection of student clinicians and supervisors.




                                              52
XIII. Requests of Patient Reports and Information “TO” and “FROM” this center

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

      The audiology clinic administrative assistant will only distribute reports with approval of
      the clinic supervisor and authorization from the patient. Reports will not be sent to
      outside sources without patient signature.

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

      It will be the responsibility of the student clinician to check that these releases have
      been obtained. If they are not, the student will obtain them.

      The student clinician will record requests to send or receive information on the routing
      slip for the audiology clinic administrative assistant to process.

      On occasion, it may be necessary for the audiology clinic administrative assistant to
      obtain authorization via fax.




                                                   53
XIV. Other Important Information

      Grand Rounds

            Mandatory Grand Round meetings are held for all first, second and third year
            students enrolled in the Au.D. Program. Students will be notified of scheduled
            times and locations. Typically, Grand Rounds are held in PCD 4004 on a monthly
            basis during each semester.

      Voluntary Clinic during Semester Breaks

            During the breaks between semesters, supervisors continue to see patients.
            Students are strongly encouraged to participate. This participation is voluntary,
            but it is seen as part of the professional responsibility of “doctors of audiology.”

            Efforts will be made to accommodate student needs, and no student should have
            to volunteer more the two to three times at most, even during the longest break
            between summer and fall semesters.

      Procedural Safeguards

            Accidents

                   If anyone has an accident or becomes seriously ill in the clinic, notify the
                   supervisor or another faculty member, immediately. Call campus
                   emergency (911) for assistance. In the event of minor injuries, a first aid
                   kit is located in PCD 1014 (wet room). Even if the injury is minor, notify the
                   supervisor and the audiology clinic assistant to document the accident.

            Seizure Procedure

                   Keep calm and have someone notify the supervisor. A seizure cannot be
                   stopped once it has started. Do not restrain the patient or try to revive
                   him/her.

                   Clear the area around the patient of hard, sharp or hot objects which could
                   injure him/her.

                   Do not force anything between his/her teeth. If the patient‟s mouth is open,
                   place a soft object (i.e., handkerchief) between his/her teeth.

                   Turn the patient‟s head to the side and make sure the breathing is not
                   obstructed. Loosen tight clothing.

                   Carefully observe the patient‟s actions during the seizure for a full medical
                   report later. When the seizure is over, let the patient rest is he/she wishes.



                                                  54
AIDS

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


Infection Control

       Infection control procedures were covered in Audiology Clinic Lab I.
       Students are to read notes for a review. Recall that students are to wash
       hands thoroughly before and after the following:
               Each patient
               The use of gloves
               Using the restroom
               Applying cosmetics
               Inserting contacts lenses

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


Procedures for evacuation of the building

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




                                     55
                    until the fire/rescue team arrives. Notify the team that we have individuals
                    who need to be evacuated. Do not use the elevator.

      Center Playground Policy

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


      Buddy/Mentor Program

               All students in SPA 4050 (Prepracticum) are assigned a graduate student as
Mentor. The Mentor/Buddy assignments are made in the second week of clinic. Graduate
students are assigned Buddies by the Audiology Clinic Director. Undergraduate students
participate in observation of their mentor on a weekly basis. The undergraduate students are
eager to support graduate students in any way. They cannot be involved in the actual
treatment or evaluation unless the mentor‟s supervisor has approved their participation. As
needed, they will ask questions and review files related to the patient. Graduate students are
to accept this extra responsibility graciously and conscientiously.




                                                  56
XV. Grading, Clinical Assistance Program, KASA Competencies, Practical Exam

     Minimum Grade Policy

           All students are required to earn a B- or better grade in clinic. Grades less than a
           B- are considered as unsuccessful completion of the practicum. In addition, clock
           hours earned during the semester will not be awarded. If a grade of B- or better
           is not earned, the student must repeat the course.

     Clinical Assistance Program (CAP)

           The CAP program is designed to provide extra clinical supervisory support to
           those students identified by their supervisors as needing extra assistance. The
           following procedures are implemented:
           1. Initial identification of an at-risk student should occur and be officially
               documented no later than midterm evaluation week of the designated
               semester.
           2. Criteria for initiating a CAP include the following, but may not be limited to: A
               score less than 80 (below a grade of B-) in any of the 5 skill areas assessed
               (Interpersonal Communication, Assessment, Written Documentation,
               Treatment ,and Professionalism/Problem Solving), as indicated by the USF
               Hearing Clinic Evaluation Form.
           3. The student is notified in writing, via the Clinical Assistance Form (CAF) by
               the primary CAP supervisor.
                   a. The student and supervisor(s) are required to sign and date the CAF.
                   b. The date indicated on the CAF becomes the official start date for any
                       CAP.
                   c. A copy of the CAF will be forwarded to the Audiology Clinic Director.
                       The Clinic Director will attend the Clinical Intervention Plan (CIP)
                       Conference along with the student and the CAP Supervisor(s) to
                       establish the criteria for successful completion.
           4. An individualized Clinical Intervention Plan (CIP) Conference is scheduled to
               establish the CAP criteria. The criteria for a CAP must include the following,
               but may not be limited to:
                   a. Specific skill areas targeted for intervention, e.g., Dx or Tx.
                   b. Documented specific competencies to be developed within each skill
                       area.
                   c. Cooperative development of specifically targeted competencies.
                   d. Documentation of whether or not the criteria for each competency was
                       met, utilizing the CAP coding system (see CAP legend) by CAP
                       Supervisor.
           5. Criteria for Completion of a CAP. Completed criteria must reflect a + (met
               criterion) each competency goal and competency rating of greater than or
               equal to 80 (B-) in each of the applicable areas. Any student failing to meet
               this criterion may:
                   a. Receive a grade o “C” or lower in the designated practicum.



                                                57
           b. Be required to repeat the designated practicum.
           c. Be counseled by the CAP Supervisor, Center Director, and/or the
              appropriate Academic Program Director, regarding future options.


Failure to meet KASA competency

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

End of the Semester Practical Exam

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




                                         58
XVI. The Student

      Professionalism

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

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

                   1.  You show up.
                   2.  You show up on time.
                   3.  You show up prepared.
                   4.  You show up in a frame of mind appropriate to the professional task.
                   5.  You show up properly attired.
                   6.  You accept the idea that “on time,” “prepared,” “appropriate,” and
                       “properly” are defined by the situations, by the nature of the task, or by
                       another person.
                   7. You accept that your first duty is to the ultimate welfare of the persons
                       served by your profession and that “ultimate welfare” is a complex mix
                       of desires, wants, needs, abilities, and capacities.
                   8. You recognize that professional duties and situations are about
                       completing tasks and about solving problems in ways that benefit
                       others, either immediately or in the long term. They are not about you.
                       When you are called on to behave as a professional, you are not the
                       patient, the customer, the star, or the victim.
                   9. You place the importance of professional duties, tasks, and problem
                       solving above your own convenience.
                   10. You strive to work effectively with others for the benefit of the person
                       served. This means you pursue professional duties, tasks, and
                       problem solving in ways that make it easier (not harder) for others to
                       accomplish their work.
                   11. You properly credit others for their work.
                   12. You sign your work.
                   13. You take responsibility for your actions, your reactions, and your
                       inaction. This means you do not avoid responsibility by offering
                       excuses, by blaming others, by emotional displays, or by helplessness.



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            14. You do not accept professional duties or tasks for which you are
                personally or professionally unprepared.
            15. You do what you say you will do, by the time you said you would do it,
                and to the degree of quality you said you would do it.
            16. You take active responsibility for expanding the limits of your own
                knowledge, understanding, and skill.
            17. You vigorously seek and tell the truth, including those truths that may
                be less than flattering to you.
            18. You accept direction (including correction) from those who are more
                knowledgeable or more experienced. You provide direction (including
                correction) to those who are less knowledgeable or less experienced.
            19. You value the resources required to perform duties, tasks, and
                problem solving, including your time and that of others.
            20. You accord respect to the values, interests, and opinions of others that
                may differ from your own, as long as they are not objectively harmful to
                the persons served.
            21. You accept the fact that others may establish objectives for you.
                Although you may not always agree with those goals or may not fully
                understand them, you will pursue them as long as they are not
                objectively harmful to the persons served.
            22. When you attempt a task for the second time, you seek to do it better
                than you did the first time. You revise the ways you approach
                professional duties, tasks, and problem solving in consideration of peer
                judgments of best practices.
            23. You accept the imperfections of the world in ways that do not
                compromise the interests of those you serve.
            24. You base your opinions, actions, and relations with others on sound
                empirical evidence and on examined personal values consistent with
                the above.
            25. You expect all the above from other professions.

            Adapted from Chial, Michael. (1998). Audiology Today, 10, pg 25.


Attendance Policy

     Attendance is mandatory at each clinical assignment for which you are
     scheduled. You are assigned to these time slots for the entire semester. On
     occasion, the student clinician may be asked to perform clinical activities during
     an unassigned time slot (would not interfere with other assigned duties the
     student may already have); this would occur in cases in which the student
     needed further experiences.

     If for any reason you cannot attend a session(s) due to illness, emergency, or
     other extenuating circumstances, notify your supervisor(s) ASAP via the front
     office phone at (813) 974-8804. Written verification may be requested. Absences



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      are not excused unless they are specifically acknowledged by the respective
      supervisor on a case-by-case basis. In the case of an illness of greater than two
      days, a note from your physician will need to be submitted to your supervisor(s).
      Discuss missed assigned clinic sessions with your respective supervisor(s); the
      make-up of missed sessions is at the discretion of your supervisor.

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

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

Clinic Attire

      Students must select from the following options for clinic attire for all clinic
      assignments on and off the USF campus:
            1. Affordable scrubs to be purchased by the student from I.Q. Outfitters
               located at 2554 E. Fowler Avenue, Tampa, Florida. Phone: (813) 631-
               7778. Pants: Cherokee brand in black or khaki. Top: Cherokee brand
               v-neck tunic in black or khaki to be embroidered with the Audiology
               USF logo. OR
            2. The green USF polo shirt with khaki pants. The USF polo shirt may be
               purchased during orientation through the USF NSSHLA Chapter.

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

Cell Phones

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

Weekly Review Meetings with Clinic Supervisors

      All student clinicians are required to schedule and attend weekly meetings with
      respective supervisors for all clinic assignments each semester in clinic. Students
      are to consult with their supervisors to arrange these meetings prior to the first
      day of clinic.

      This time is valuable to both the student and the supervisor. These meetings are
      important to the success of the students‟ clinical sessions. As a result
      clinical sessions are run more smoothly and a more professional atmosphere is
      created for the student clinician, supervisor, and the patient.



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Prior to attending the weekly meeting each student is to review patient files,
develop plans of action to be discussed, and review clinic equipment, procedures
and programs that may be needed for the patient. In addition, the student‟s
performance on patients previously seen may be discussed. Supervisors will
provide guidance and assistance as needed.




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Description: Audiology Clinic Handbook C tinnitus