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Description of Audiology Clinic Services

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					            East Carolina University
Department of Communication Sciences & Disorders




           Audiology Clinic Handbook
                   Fall 2008
Index
   1. Overview of Audiology Clinic Services
   2. Expectations for Audiology Student Clinicians
      a. CSDI Technical Standards
      b. Professional Behaviors
              1. Scope of Practice (ASHA & AAA)
              2. Code of Ethics Summary (ASHA & AAA)
              3. Professional Behaviors Expected of Audiology Doctoral Student Clinicians
              4. Dress Code
      c. SAHS Student Code of Conduct
   3. Clinical Practicum
          a. General Guidelines
          b. Clinical Sequence, Protocols & Procedures
          c. Development of Clinical Skills
          d. Clinic Report Samples & Templates
          e. Liability Insurance
          f. Hepatitis B Vaccination/Declination
          g. HIPAA Overview & Training
          h. Bloodborne Pathogens & Infection Control Overview & Training
          i. Preparation for Clinic
          j. Logging Clock Hours
          k. Weekly Clinic Meeting
          l. Other Clinic-Related Activities
          m. ASHA Knowledge and Skills
          n. Evaluation of Clinical Performance
          o. FERPA Memorandum
          p. Student Confidentiality Statement
          q. Annual Required Activities
          r. Student Accommodations
   4. Clinic Facilities
          a. Location
          b. Clinic Office
          c. Student Work Room
          d. Mailboxes
          e. Patient Waiting Room
          f. Supplies and Materials Room
          g. Audiology Clinic Areas
          h. Copy Machine
          i. Keys
          j. Telephones
          k. Handicap Access
          l. Directions to the Clinic
          m. Map
          n. Parking
          o. Local Physicians, Schools, and Agencies
5. Clinic Procedures
       a. Clinic Assignments
       b. Clinic Appointment Scheduling in Regular Appointment Blocks
       c. Other Scheduling of Clinic Areas
       d. Clinic Cancellation
       e. Clinician Absences
       f. Patient Folders & Documentation
       g. Clinic Forms
       h. Billing Procedures
       i. Lines of Communication
6. Clinic Maintenance
       a. Daily checks
       b. Clean up
       c. Reporting of Supply Needs
       d. Reporting of Faulty Equipment


Appendices       A     (Section 2 Documents)
                 B     (Section 3 Documents)
                 C     (Section 4 Documents)
                 D     (Section 5 Documents)
                 E     (Section 6 Documents)
                             1. Overview of Audiology Clinic Services


         The Audiology Clinic at the ECU Speech-Language and Hearing Clinic offers services to
individuals of all ages including infants, toddlers, school-age children, young adults, middle aged
adults, and geriatrics. Individuals may be self-referred or referred by family, friends, or medical
practitioners. The primary focus of our services is to identify, describe, and lessen the impact of
hearing and balance problems. Services are generally characterized as either diagnostic or
rehabilitative in nature.
         The diagnostic services offered through our clinic relate to three primary areas: 1) hearing
evaluation, 2) auditory processing evaluation, and 3) vestibular evaluation. Testing that allows for
comprehensive hearing evaluation includes but is not limited to: auditory evoked potentials,
otoacoustic emission measures, tympanometry, acoustic reflex thresholds, behavioral air and bone
conduction thresholds, otoscopy, and speech audiometry. Testing of auditory processing typically
includes but is not limited to hearing evaluation and assessment of auditory closure, binaural
integration & separation, auditory temporal patterning, auditory temporal resolution, and binaural
interaction. Finally, vestibular assessment may include VENG and rotary chair testing.
         The rehabilitative services offered through our clinic relate to three primary areas: 1) hearing
aid fitting & related aural rehabilitation, 2) assistive listening devices & related aural rehabilitation,
and 3) cochlear implant fitting & related aural rehabilitation. In each area, aural rehabilitation may
consist of auditory training, speechreading, communication strategies and counseling to further
improve communication function.
         In addition, our audiologists offer several community-based audiology service programs
including: 1) hearing screenings; 2) aural rehabilitation programs in retirement home facilities; 3)
hearing aid, FM, and earmold services at the Eastern North Carolina School for the Deaf; and 4)
educational services for the Rocky Mount-Nash School system.
                        2. Expectations for Audiology Student Clinicians

        2a. CSDI Technical Standards
        In order to ensure that patients receive the best possible health care, the faculty of the
Communication Sciences and Disorders program has identified certain skills and professional
behaviors that are essential for successful progression of CSDI students in the program. Students
who can perform these skills and successfully execute professional behaviors either unassisted,
with dependable use of assistive devices, or by employing other reasonable accommodations
are eligible to apply for and maintain enrollment in the program.

Minimum technical standards include:

Critical Thinking: All students must possess the intellectual, ethical, physical, and emotional
capabilities required to undertake the full curriculum and to achieve the levels of competence
required by the faculty. The ability to solve problems, a skill that is critical to the practice of
Speech-Language Pathology and Audiology, requires the intellectual abilities of measurement,
calculation, reasoning, analysis, and synthesis. Successful graduates of the program must be able to
integrate knowledge into practical skills.

Communication Skills: A candidate should also be able to speak, to hear, and to observe patients
in order to elicit information. The candidate must be able to communicate effectively and efficiently
in oral and written forms.

Auditory-Visual Ability: Candidates must also be able to observe a patient accurately, both at a
distance and close at hand. This ability requires the functional use of audition and vision.

Mobility and Fine Motor Skills: A candidate should be able to execute movements reasonably
required to move from area to area, maneuver in small places, calibrate and use small equipments,
and provide patients with general care.

Interpersonal Abilities: A candidate must possess the emotional health required for full utilization
of his or intellectual abilities, the exercise of good judgment, the prompt completion of all
responsibilities required for the diagnosis and care of patients, and the development of mature,
sensitive, and effective relationships with patients, families, and colleagues.
        2b. Professional Behaviors
        Students are advised that ASHA certified audiologists refer to the Scope of Audiology
Practice document (See Appendix A) to review areas of audiology practice and the Code of Ethics
(See Appendix A) to indicate ethical practice.

               2b1. Scope of Practice (ASHA & AAA)
        Audiology practice includes a comprehensive array of professional services related to the
assessment, habilitation/rehabilitation of persons with auditory and vestibular impairments, and to
the prevention of these impairments. (This is a summary statement only. Please see documents in
Appendix A for details).

               2b2. Codes of Ethics Summary (ASHA, AAA)

ASHA:
Principle 1: Hold paramount the welfare of persons they serve
Principle 2: Achieve and maintain the highest level of professional competence
Principle 3: Serve the public by providing information & developing needed services
Principle 4: Uphold the dignity and autonomy of the profession & maintain harmonious
               Inter-professional & intra-professional relationships & accept the
               professions‟ self-imposed standards
AAA:
Principle 1: Provide services with honesty and compassion & respect dignity, worth, and
               rights of those served
Principle 2: Maintain high standards of competence & provide only services for which
               they are qualified by education & experience
Principle 3: Maintain confidentiality of information and records of those receiving
               Services
Principle 4: Provide only services & products in the best interest of those served
Principle 5: Provide accurate information about the nature & management of disorders,
               products, and services
Principle 6: Members shall comply with the ethical standards of the Academy with regard
               to public statements
Principle 7: Honor their responsibilities to the public & to professional colleagues
Principle 8: Uphold the dignity of the profession & accept the Academy‟s self-imposed
               standards
               2b3. Professional Behaviors Expected of Audiology Doctoral Student Clinicians

Ethical Conduct
       Student clinicians will:
       insure the welfare of clients by complying with the ASHA Code of Ethics (see Appendix A),
       as directed by the clinical supervisor.

Confidential and Safe Practice
   Student clinicians will, on an annual basis:
      review and sign the clinic confidentiality statement and adhere to that stated policy;
      review university HIPAA policy, submit documentation of training to the clinic director, and
      adhere to the stated policies;
      review Bloodborne Pathogens and the Clinics‟ Infection Control plan, take the related quiz,
      and adhere to the stated policies.

Preparation for Clinic
   Student clinicians will, on a regular basis:
      discuss clinical goals with the supervisor;
      plan for clinical sessions & insure that appropriate materials are available;
      arrive on time for clinical sessions, as directed by the supervisor;
      seek ways to expand clinical knowledge, skills, and abilities.
Clinical conduct
   Student clinicians will:
       follow clinic procedures related to client intake, testing, and documentation, as directed by
       the supervisor;
       refrain from the use of informal and/or casual language;
       show appreciation for clinical views differing from their own;
       show positive regard to supervisors, clients, families, & others;
       demonstrate self-evaluation of performance during clinical sessions;
       avoid excusing or blaming behaviors.

Clinical Follow-up
   Student clinicians will:
       complete follow-up activities and reports in a thorough and timely manner as directed by the
       supervisor.
       set meeting times to discuss clinical performance with the supervisor.
       seek ways to expand clinical knowledge, skills, and abilities;

Clinical supervisors may choose to cite a student with professional misconduct if these prescribed
behaviors are not followed. Please see Appendix A for “the Notice of Professional Misconduct”.
That notice requires a meeting between the supervisor and clinician. Possible follow-up actions
could include one or more of the following: lowering of clinical evaluation ratings, lowering of the
clinic grade, withdrawal from clinic, charges related to violation of the SAHS Code of Conduct.

Clinic supervisors also might choose to site a student clinician for demonstrating excellence in
professionalism. The supervisor may complete the “Notice of Professional Excellence” (Appendix
A) and once signed by involved parties the notice may go to the Audiology Clinic Director so that it
can be placed in the student‟s clinic file.
       2b4. Dress Code

       Most clinics have their own dress codes. Professionals in our field often are expected to
wear either nice casual or dress clothes when seeing clients. When you are at an off-campus clinic,
you need to learn about and follow their dress code.

       If you are seeing clients in the ECU Clinic the following is recommended:

Males: Slacks, dress pants with dress shirts, polo shirt, sweater with shirt, nice casual or dress
shoes; coat and tie are very appropriate, but not required;

Females: Dresses, dress slacks, business suit, skirts, dress shorts (skorts), and blouses, nice casual
or dress shoes;

Unacceptable attire: blue jeans, tee shirts, tank tops, sundresses without jackets, shorts, flip-flops
and tennis shoes are not acceptable. If working with patients confined to wheelchairs, open-toed
shoes are inappropriate due to safety concerns.

It is important to be discreet regarding necklines and dress/skirt length. A good guideline to follow
is that hemlines should be no more than 2 inches above the knee. Midriffs should not be visible
when arms are raised and undergarments should never be visible. It is also important to limit
jewelry, perfumes, and colognes. If working with children consider whether you will need to be on
the floor and dress accordingly.

       If you are in the ECU Clinic but not seeing clients:

You may wear casual clothes but they cannot be torn, dirty, ragged, too tight, or too short.
       2c. School of Allied Health Sciences Student Code of Conduct

     The University policy (Student Handbook and Academic Year Planner – “Clue Book”)
regarding student conduct states, “students enrolled at ECU are expected to uphold at all times
standards of integrity and behavior that will reflect credit upon themselves, their families, and East
Carolina University”. Additionally, the faculty of the School of Allied Health Sciences (SAHS) has
an academic, legal and ethical responsibility to protect the public and health care community from
inappropriate professional conduct or unsafe behaviors in the practice of Allied Health Professions.

Students will be provided with documents expressing expectations regarding academic and
professional conduct within all academic and clinical aspects of the curriculum during general
advisement sessions, course work, clinical affiliations, and other instructional forums. All SAHS
students are expected to be familiar with their department policies and professional code of ethics
and to conduct themselves in accordance with these standards. See Appendix A for the entire
SAHS Student Conduct Code.
                                       3. Clinical Practicum

         3a. General Guidelines
         Throughout the course of audiology doctoral studies, student clinicians must complete a
minimum of the equivalent of twelve months full time supervised clinical practicum (or 1820
hours). These clinical hours are to be achieved through a variety of practice settings with a diversity
of clients.
         For all students, clinical practicum will begin in the first summer semester of the program
and clinical supervisors will determine when supervisees are able to move from supervised
observation into supervised clinical service delivery. This decision will differ depending upon the
knowledge and abilities of the student clinician and the specific clinical procedure(s) performed.
Typically, coursework related to a procedure must be concurrent or completed prior to clinical
participation involving that procedure. However, clinical supervisors may offer clinic-based tutorial
and readings to allow for clinical participation.
         All students will rotate through placements in the ECU Speech-Language & Hearing Clinic
and formally approved off-campus sites. Student clinicians may only attend sites that are approved
by the audiology clinic director and for which an affiliation agreement is in force.
         For most audiology clinic schedule blocks in the ECU Speech-Language & Hearing Clinic,
one student clinician is assigned to one audiology clinic supervisor. In some designated schedule
blocks, where full and active participation of two student clinicians is expected there may be two
student clinicians assigned to a clinical session block. This is generally restricted to pediatric
hearing evaluation for children up to 5 years of age and to auditory processing evaluations. At
times, one audiology clinic supervisor might oversee the supervision of two concurrent schedule
blocks; e.g., an experienced clinician with one client and a less experienced clinician with a second
client, or two experienced clinicians each seeing their own clients.
         When a student enrolls in clinical practicum, it is expected that the student will participate
through the end of the designated clinical assignment (i.e., typically the end of one or two
semesters). Withdrawal from a clinical assignment would be a rare circumstance that would usually
require a determination following consultation with the student, supervisor, and audiology clinic
director. The determination also would generally include a plan for how to successfully re-
introduce the student into clinic in the future.
        3b. Clinical Sequence, Procedures & Protocols
        The term “sequence” refers to the recommended order of the clinical session or
appointment. An example of a typical sequence is offered in Appendix B.
        The term “procedure” refers to a series of designated steps undertaken in order to complete a
needed audiological measure (e.g., ASHA Pure Tone Audiometry procedure used to establish pure
tone thresholds). Appendix B offers a designated set of audiology procedures. However, students
need to remember that there often is more than one valid procedure and that the selection of
procedures varies depending upon the practice setting, audiologist, and/or client needs. The choice
of appropriate procedures should be evidence-based (i.e., based on research) and include
considerations of practice setting and client needs.
        The term “protocol” refers to a designated set of clinical procedures appropriate for
assessing an individual‟s needs. For example, if a 9-month-old child is referred for a pediatric
hearing evaluation then a protocol or set of clinical procedures appropriate for assessment of that
age child may guide the audiologist in obtaining the necessary measures. Appendix B offers a
designated set of audiology clinic protocols. Once again, a clinical protocol is not intended to offer
a cookbook approach to assessment. Clinical protocols also vary depending upon the practice
setting, audiologist, and/or client needs. The choice of appropriate clinic protocols should be
evidence-based (i.e., based on research) and include considerations of practice setting and client
needs.

        3c. Development of Clinical Skills
    Clinical skills develop over time. Students will move from limited knowledge and skills to
basic knowledge and skills to advanced knowledge and skills. At all times, student clinicians are
expected to demonstrate a professional attitude in behavior, speech, and attire. If student clinicians
are uncertain about a clinical procedure or protocol, then they are to advise the client that they need
to check with the supervisor before proceeding.
       3d. Clinic Report Samples & Templates
       Student clinicians may request clinic report samples and templates from their clinic
supervisor(s). A few sample reports are offered in Appendix B. Often, clinic supervisors will offer
to provide student clinicians with clinic report templates.

        3e. Liability Insurance
        Liability insurance needs to be paid at the beginning of each fall semester of practicum. The
policy is good for one year. The cost of insurance varies slightly from year to year. Students will be
advised of the cost and payment process during the fall clinic orientation meetings.

        3f. Hepatitis B Vaccination/Declination
        Students must review and sign the Hepatitis B vaccination/declination form (See Appendix
B) to either indicate that s/he has completed the series, intends to start the series, or declines the
series of vaccinations. Students need to be aware that while participation in the ECU Speech-
Language & Hearing Clinic is possible for those declining there are off-campus sites that require the
vaccination series for students wishing to be placed.

         3g. HIPAA Overview & Training
         The HIPAA overview and training takes place in two forms. The HIPAA policies are
reviewed during the fall clinic orientation sessions. Throughout the year, students and faculty are
directed to participate in university computer-based training and review, with documentation of
participation to be submitted to the audiology clinic director. All faculty and students participating
in a clinical activity are required to complete the HIPAA training and refresher courses on an annual
basis. Web-based training is available at: http://www.ecu.edu/hiss/hipaa.htm

The basic HIPAA forms used most commonly by clinicians and supervisors are:
       Notice of Privacy Practices ---client and supervisor sign top of packet, packet is given to
       client for reading (usually at another time);
       Individual Request for PHI---client and supervisor fill out form to allow for release of
       specified reports to client or parents/guardian;
       Authorization for Use of Disclosure of PHI---client and supervisor fill out form to allow
       for release of specified reports to other parties;

   Further information on HIPAA forms is available in Appendix B.
     3h. Bloodborne Pathogens and Infection Control Overview and Training
         The BBP and Infection Control training is conducted annually along with the fall clinic
orientation sessions. The clinic has its own infection control and sterilization plans. (See Appendix
B). All faculty and students participating in clinical activities are required to undergo yearly training
to limit the spread of infectious diseases. Specific policies will be reviewed; however, key features
include the need for:
         handwashing before and after each client;
         use of gloves when client has a known infectious disease or when there is an open
         sore/wound on the client or clinician (Universal Precautions);
         use of gowns/lab coats and/or goggles to prevent bodily fluids from making contact;
         discarding disposable items (e.g., immittance tips, speculum) after use;
         disinfecting clinical areas and items that clients come into contact with but that are not
         contaminated;
         discarding or sterilizing items that are contaminated (blood, bodily discharge, mucous,
         earwax);
         reporting clinician contact with contaminated substances to the supervisor and/or one of the
         Clinic Directors (Speech-language pathology: Dr. Betty Smith; Audiology: Dr. Deborah
         Culbertson);

ECU Infection Control policies are available at:

http://www.ecu.edu/prospectivehealth/infectioncontrol/Policies.htm
    3i. Preparation for Clinic
    The student clinician is responsible for reviewing his/her scheduled clients at least 24 to 48
hours in advance. The clinician should make contact with the designated supervisor, and advise the
supervisor of the clients and the clinician‟s plan for working with each client. The clinician and
supervisor will determine the need for meeting to discuss the clients, or pursuing readings or
procedural reviews before the clinical session.
    Scheduled speech-language and/or hearing screenings are typically posted on sign-up sheets in
the student work room. Other audiology services are scheduled in the Audiology Clinic
appointment book in the Clinic Office. When audiology services have been scheduled in the
appointment book there is a designation as to the type of appointment scheduled, the name and age
of the client, and an intake form or client folder that may offer background information on the client
to be seen.
    On the day of your clinical session, student clinicians should arrive early as directed by the
supervisor in order to check equipment, materials, sound booths, and clinical procedures rooms.
Student clinicians should have a plan for the procedures to be performed during that clinical session
and should bring their Clinical Feedback Notebooks (See Clinical Feedback Forms in Appendix B).
    3j. Logging Clock Hours
        Students are required to log clinical activities on the “Audiology Clinical Clock Hour Log
Sheet” (Appendix B) and to have these signed by the clinical supervisor ideally on the same day
but no later than one week after the designated clinical activities. Students should make personal
copies of completed log sheets, enter their hours into the Audiology Clock hour program, and
submit originals of the clock hour sheets to the audiology clinic director. Failure to enter clock
hours and submit log sheets by the end of the semester will result in the assignment of an
incomplete for the practicum grade. This information is necessary for ASHA certification and it is
the student‟s responsibility to maintain accurate records. The clock hour log sheet information is
entered into the Audiology Clock hour program so that clinical clock hour summaries can be
obtained and be available to the student, his/her advisor, and the audiology clinic director.

        3k. Weekly Clinic Meeting
        As part of the semester clinic assignment, audiology student clinicians enrolled for
practicum in the ECU Speech-Language & Hearing Clinic are required to attend weekly audiology
clinic meetings. If students are unable to attend some or all of these meetings then they must
formally advise the audiology clinic director and obtain approval in advance. The weekly clinic
meetings will include reviews of clinic procedures, practices, and case studies. Students will be
assigned to make presentations on each of these throughout the semester. This will serve as
excellent practice for the final Clinical Defense that also will include these types of activities.
        3l. Other Clinic-related Activities
        Audiology student clinicians may be invited to participate in audiology clinic activities
above and beyond assigned clinical blocks. Examples of extra clinical activities include community
speech-language and/or hearing screenings and audiology appointments that need to be scheduled
outside the regularly scheduled clinic blocks. Participation in these clinical activities is voluntary
and students need to ensure that participation would not negatively impact classroom and/or work
assignments, as indicated by their course instructors, assistantship supervisor(s), and/or academic
advisor.
        Audiology student clinicians may be asked to develop and offer talks to community groups
and/or classes within the department. Typically, an instructor, advisor, or clinical supervisor will
assign the talk and then oversee its development and presentation. The talks may be a required
course assignment or a voluntary activity. If a voluntary activity, students need to make sure that it
does not conflict with other coursework, clinical activities, and assistantship activities.

        3m. ASHA Knowledge and Skills
        The ASHA has designated the knowledge and skills to be developed throughout the
audiology doctoral program. Clinical knowledge and skills may be gained through didactic
coursework, labs, clinical practicum, the Clinical Residency Course, or in preparation activities for
the final Clinical Defense. The “East Carolina University Evaluation of Clinical Audiology
Competence” form (see Appendix B) allows clinical supervisors a way to rate clinical knowledge
and skills at the midterm and at the end of semesters. In addition, each audiology student clinician
has a “Clinical Feedback” notebook with forms available for the supervisor to comment on
performance during daily clinic sessions.
        3n. Evaluation of Clinical Performance
        Audiology clinical supervisors are asked to offer regular verbal and written feedback on
clinical performance. Evaluation may be offered during clinical sessions, in scheduled meetings,
and through use of designated written feedback tools. Session evaluations may be evaluated in
writing through use of the “Clinical Feedback Form (see Appendix B). At midterm and at the end
of the semester, supervisors are asked to complete the “ECU Evaluation of Clinical Audiology
Competence” (also in Appendix B).
        As part of the evaluation process, audiology clinic supervisors are asked to notify the
audiology clinic director as soon as possible if a student‟s clinic performance related to professional
behaviors; knowledge and/or skills are judged to be adequate, marginal or inadequate OR if the
student may possibly receive a grade of C or F. In these situations, increased written documentation
is often essential. The clinic supervisor and audiology clinic director will discuss the situation and
then generally a meeting with the student will be established. Ideally, problems will be noted and
effectively communicated prior to the end of the clinical placement so that the student clinician has
an opportunity to make changes. In situations where a student clinician is withdrawn from clinic
due to problem behaviors or a final grade of “C” is assigned, that student generally will be required
to participate in the ECU Speech-Language & Hearing Clinic the subsequent semester with a formal
written remediation plan that has been signed by both the student and the audiology clinic director.
        3o. FERPA Memorandum
        According to FERPA, information on student coursework and/or performance may not be
shared with individuals other than faculty members with a legitimate educational interest. This
means that information related to your coursework and/or performance can be shared with other
faculty supervisors. You will be asked to sign a FERPA permission (Appendix B) to allow the
audiology clinic director to discuss your coursework and/or performance with off-campus
supervisors. The purpose of that type of communication is to allow off-campus supervisors to
determine whether you have the skills and knowledge to succeed at their site and the types of
clinical activities in which you might participate at that site. Failure to permit this information
exchange could result in a supervisor refusing your participation at their clinical site.

       3p. Student Confidentiality Statement
       Client confidentiality is critical. All students must understand and commit to maintaining
confidentiality and will be asked to sign an agreement at the beginning of every year of clinic. See
Appendix B for that notice.
3q. Annual Required Activities
At the beginning of each year, student clinicians will be required to:
a. participate in annual orientation sessions;
b. sign confidentiality statement;
c. sign FERPA memorandum;
d. bring a check for liability insurance;
e. complete the HIPAA training at www.ecu.edu/hiss?HIPAA/hipaa.htm, take the quiz, and
    submit the quiz to the audiology clinic director if it was not completed the prior spring.

3r. Student Accommodations
Students needing accommodations are asked to follow procedural guidelines to request those
accommodations. Please see Appendix B.
                                          4. Clinic Facilities

        4a. Location
        The Audiology Clinic is located within the ECU Speech-Language & Hearing Clinic in
Room 1310 of the Library, Allied Health, & Nursing Building on Highway 43 North. Signs are
available to direct our clients to clinic parking on the side of the building complex, and parking is
free to our clients. Clients should sign in at the clinic office and obtain a parking pass to place in
the front driver side window to confirm their status in patient parking.

        4b. Clinic Office
        The Clinic Office, open from 8:00 AM to 5:00 PM Monday through Friday, is located in
Room 1310 of the Library, Allied Health, & Nursing Building. The front office staff manages that
office with the assistance of student workers. Client folders are stored in the locked room behind the
clinic office.

      4c. Student Work Room
      The student work room is located in Room 1310B. This workroom includes multiple
computer workstations for the purpose of clinical reporting and student mailboxes.

        4d. Mailboxes
        Student mailboxes are located in the student workroom (1310B) and these boxes should be
checked on a regular basis for important messages related to clinical and other academic notices.
Faculty mailboxes are located on the departmental floor (3rd floor) in room 3310C, and some
clinical supervisors also have a mailbox in the student workroom.

       4e. Patient Waiting Room
       The client waiting room is located in Room 1310 of the Library, Allied Health, and Nursing
Building. Student clinicians should meet their clients in the waiting room prior to appointments.
Communication in the waiting room is not confidential and thus should be restricted only to
greetings and farewells rather than the exchange of information.
       4f. Supplies and Materials Room
       The supplies and materials room is located in Room 1310L. While most audiology clinic
supplies are stored in the clinic booths and audiology procedures rooms, other supplies, materials,
screening equipment, and speech-language tests are stored in the supplies and materials room.

       4g. Audiology Clinic Areas
       Room 1310 E: Hearing Aid Procedures
       Room 1310F: Cochlear Implant/Aural Rehabilitation Services
       Room 1310G: Counseling/Otoscopy/Tympanometry
       Room 1310H: ENG/Evoked Potentials Room
       Room 1310H: Rotary Chair Room
       Room 1310K: Pediatric Test Booth
       Room 1310C: Adult Test Booth
       Room 1310D: Hearing Aid Test Booth

       4h. Copy Machine Use
       The clinic copy machine is intended for use by clinical staff and faculty. Students, however,
may use the copy machine if offered a staff/faculty copy code and directed to make copies for clinic
purposes. Personal copies of other materials can be made at the library.
        4i. Keys
        The clinic supervisors and front desk staff have keys that open the ECU Speech-Language &
Hearing Clinic and clinic procedures rooms. At the beginning of each weekday, the front office staff
will unlock the front door to the clinic. They will also unlock but close each of the audiology
procedures rooms. At the end of the day, the front office will lock the procedures rooms and the
front door to the clinic.


      4j. Telephones
      The telephones within the ECU Speech-Language & Hearing Clinic are for use related to the
conduct of the clinic. These phones are not to be used for personal uses.

        4k. Handicap Access
        The ECU Speech-Language & Hearing Clinic has been designed for handicap accessibility.
Client and family requests for further assistance should be directed to the faculty supervisor.
       4l. Directions to the Clinic

Traveling from Rocky Mount:
Take 43 South into Greenville
Pass McGregor Downs Road on right
Turn right into LAHN Bldg. parking lot
Follow signs to clinic & designated parking

Traveling from 264 East:
Take 264 E into Greenville & road name      changes to Stantonsburg Rd.
Turn left onto Memorial Drive
Turn left onto 5th St. & go down several    blocks
Turn left into LAHN Bldg parking lot
Follow signs to clinic & designated parking

Traveling from 11 North:
Take 11 North into Greenville where road name changes to Memorial Drive
Turn left onto 5th St. & go down several    blocks
Turn left into LAHN building parking lot
Follow signs to clinic & designated parking

Traveling from Washington:
Take 264 West & turn left onto Greenville Blvd.
Turn right onto Arlington Blvd.
Go to end of Arlington Blvd. & turn right onto Macgregor Downs Rd.
Go to end of Macgregor Downs Rd. & turn right onto 5th St.
Turn right into LAHN building parking lot
Follow signs to clinic & designated parking
4m. Map
        4n. Parking
        Parking is free to clients of the ECU Speech-Language & Hearing Clinic. Signs are
available to direct our clients from Highway 43 to the dedicated parking spaces on the side of the
building. If those spaces are full, clients may park in other available parking in that side lot or in
the front lot. Clients should sign in at the clinic office and obtain a parking pass to place in the front
driver side window to confirm their status in patient parking. If clients have handicap parking tags
then they may park in the designated handicapped spaces.

        4o. Local Physicians, Schools & Agencies
        Local physicians, schools and agencies are important sources of mutual client referral.
Student clinicians and supervisors are encouraged to ask clients if we may send reports to
physicians, schools and agencies. Those reports offer specific client information but also increase
our visibility in the community and offer a means of further marketing our services.

                       5. Clinic Procedures

       5a. Clinic Assignments

        The audiology clinic director communicates with audiology faculty with assigned
supervision to discuss specifics related to days and times of clinic blocks and types of clients to be
scheduled in those blocks. Then the audiology clinic director assigns student clinicians to those
blocks and advises both students and supervisors of the assigned clinic blocks. If there is a need for
either a student or supervisor to change a clinic block, then s/he should communicate with the
audiology clinic director.

        5b. Clinic Appointment Scheduling in Regular Appointment Blocks
        Audiology clinic scheduling is generally handled by the Clinic Office staff. Prior to each
clinic semester, and as needed throughout the semester, a summary of procedures and appointment
blocks is provided to the staff to assist with their scheduling. At the time of scheduling, staff are
asked to complete an intake card and then write in the schedule book the requested procedure(s),
client‟s name, age, contact person and phone number. If staff has questions about scheduling they
are asked to direct those questions to the audiology clinic director. If there is a need to change a
clinic block, then there should be communication with the audiology clinic director.
        Audiology supervisors, at times, may schedule appointments and follow-up visits and they
also must insure that an intake card has been completed and that the client‟s name, age and contact
information be written in the schedule book.
        5c. Other Scheduling of Clinic Areas
        The Audiology Clinic is intended for use by faculty and students seeing clients, conducting
labs, practicing procedures, and conducting research. Once the semester‟s clinical appointment
blocks are entered, faculty and students may reserve clinic areas for other uses. The clinic areas that
are open for other scheduling are designated in the Audiology Clinic appointment book. Those
wishing to reserve these areas are asked to designate the room(s) and times needed, purpose for the
reservation, and their name in pencil in the appointment book.

        5d. Clinic Cancellation
        In the ECU Speech-Language & Hearing Clinic, the clinic will be closed during university
breaks (for regularly scheduled clinic blocks), for designated holidays, and for certain special events
such as the annual spring symposium. If the university closes due to inclement weather then the
clinic will also close. Occasionally, a clinic supervisor may need to cancel a clinic block due to
another professional activity.
        If a student clinician is placed off campus then that student clinician must attend clinic on
regularly scheduled days even if the university is on break for those days.
        5e. Clinician Absences
        If a student knows in advance of an important reason that s/he may not participate in a
clinical assignment then s/he should communicate with his/her supervisor as soon as possible. If
that student is placed in the ECU Speech-Language & Hearing Clinic and is unable to participate in
a clinical session, then the student should seek another student clinician to cover that clinic block
and advise both the supervisor and the audiology clinic director of that substitution. Student
clinician absences should be a rarity and if considered problematic then the supervisor should alert
the student and the audiology clinic director of the situation.

        5f. Patient Folders & Documentation
        Student clinicians should request client folders or intake forms from the front office prior to
clinical appointments in preparation for their clinical sessions. Client folders and/or intake cards
may be taken to the student work room during clinic operating hours but should never be left
unattended and should never leave the building. At the close of each day, client folders should be
secured in the locked clinic office file room or in a locked clinical supervisor‟s office. Client
reports may be saved to the pirate drive on the computers in the student workroom or in the
audiology procedures rooms. Client data is not to leave these sites and students doing so are at
risk for a Notice of Professional Misconduct and/or HIPAA Violation Report.
        At the end of clinical sessions, student clinicians should, with the assistance of their
supervisors, develop SOAP notes to log on the patient folder contact sheet and discuss information
for the formal typed report. Client files with pending reports are filed in the cabinet in room 1310E.
Generally, first drafts of clinical reports are to be completed within 48 hours of a clinical session but
students need to communicate with supervisors about report deadlines. After the final draft has
been completed, the final signed report and client chart should be placed in the “Audiology Active”
basket in the front office. The front office will make the needed copies of the report, mail
designated reports, organize and secure materials in the client folder, and file the folder.
        5g. Clinic Forms
        The majority of clinic forms including case histories, audiograms, and test forms are
available in the sound isolated test booths in the tester side file drawers. If any form is running low,
please request additional copies from the Clinic Office. Student clinicians and/or faculty are asked
to advise the audiology clinic director if forms are needed or are missing.

        5h. Billing Procedures
        Clients seen in the clinic will receive a School of Medicine billing sheet from the Clinic
Office. The audiology clinic supervisors in the ECU Speech-Language & Hearing Clinic are
responsible for completing the coding on the clinic billing sheets. They should familiarize
themselves with the CPT billing codes and the ICD-9 diagnostic codes and the manner in which
these forms are to be completed. Whenever possible, clinic supervisors should discuss and include
student clinicians in the process of completion of the billing sheet so that students may learn about
billing procedures. It should be noted that while most clinical procedures are billed using the
School of Medicine billing sheet, the exception is hearing aid billing which is billed through use of
an in-house billing protocol.
        While the coding on the billing form is to be completed by the audiology clinic supervisor,
the Front Office staff writes in the fee amounts and discusses issues related to payment and/or
insurance submission. Payment may be made in cash, by check, VISA, or Master Card. Further
information on billing is found in Appendix D.
        Audiology supervisors dispensing hearing aids through the clinic are responsible for
discussing the related charges and advising the department‟s Fiscal Agent as to the payment
schedule. Typically, clients pay 50% or more of the overall hearing aid charges on the fitting date
and the “Hearing Aid Purchase Agreement” (Appendix D) is completed at that time. If the hearing
aids are kept, as they usually are, the client is then asked to set up a monthly payment plan with
suggested payments of $200 or more per month until the full amount has been received. The Fiscal
Agent sends clients a monthly billing until full payment has been received. In circumstances, where
hearing aids are returned then the audiology clinic supervisor must complete a hearing aid refund
form that is to be submitted to the Dean‟s Fiscal Agent.
        5i. Lines of Communication
        In the event that a student or supervisor observes a problem with a clinical assignment (e.g.,
related to student clinical performance or supervisory support), a meeting of that student and
clinical supervisor should be scheduled. That meeting should be documented in writing with regard
to issues discussed and the proposed resolution of those issues. Documentation of that meeting
should be kept by the supervisor, the student, and a copy should be made available to the audiology
clinic director.
        If the meeting does not resolve the issue(s), then the student and/or clinical supervisor
should contact the audiology clinic director. She will set up a meeting and act as a facilitator. If the
unresolved concern is with the audiology clinic director, then the student should contact his/her
academic advisor or the department chair to serve as the facilitator. Involvement of the department
chair would be the last level of involvement for resolving the issue.

                       6. Audiology Clinic Maintenance

       6a. Daily checks
       Student clinicians are expected to check all equipment to be used in clinic prior to the
beginning of clinical sessions. See Appendix E for audiometer visual-listening check.

        6b. Clean Up
        Student clinicians and clinical supervisors are expected to clean up materials and areas used
during their clinical sessions. The CSDI Infection Control Plan (See Appendix B) should be
referred to with respect to cleaning, disinfection, and sterilization procedures.
        If housekeeping is needed to assist with cleaning, then please place this request through the
front office.

       6c. Reporting of Supply Needs
       Student clinicians and clinical supervisors are asked to report supply and equipment needs as
soon as possible to the audiology clinic director.

       6d. Reporting of Faulty Equipment
       Student clinicians and clinical supervisors are asked to report faulty equipment to the
audiology clinic director and Mr. Mark Allen. The clinical supervisor needs to determine whether a
note should be placed on the equipment to indicate that it should not be used until problems are
resolved.
               Appendix A

ASHA Scope of Practice
ASHA Code of Ethics
Notice of Misconduct
Notice of Excellence
SAHS Student Conduct Code
SAHS-Communication Sciences & Disorders
LAHN Building
Greenville, NC 27858
                          Notice of Professional Misconduct

To:    _____________________________________________, Student Clinician
From: _____________________________________________, Clinic Supervisor
Date: _____________________________________________
       On _______ (date) you:




This behavior is not consistent with the professional standards for audiology student clinicians in
the Department of Communication Disorders at East Carolina University.

You should review expectations for professional conduct in the Audiology Clinic Handbook. If you
have not already done so, please make an appointment with me to discuss the behavior(s) described
above. At that time, the behavior(s) will be discussed and you will be asked to change the
behavior(s) of concern. In some circumstances, unprofessional behavior(s) may result in the
lowering of clinical evaluation ratings and a clinic grade and if serious could lead to withdrawal
from a clinical assignment, and/or charges related to the School‟s Code of Conduct.

Please indicate that you have read this memo by signing and dating it and leaving it immediately in
my mailbox. A copy of this memo will be given to the Audiology Clinic Director who will place it
in your clinical file.

___________________________________                  _________________________
Student Clinician                                    Date

__________________________________                   _________________________
Clinic Supervisor                                    Date

C:     Audiology Clinic Director
       Student Clinician
SAHS-Communication Sciences & Disorders
LAHN Building
Greenville, NC 27858
                           Notice of Professional Excellence

To:    _____________________________________________, Student Clinician
From: _____________________________________________, Clinic Supervisor
Date: _____________________________________________
       On _______ (date) you:




This notice is to commend you for excellence in demonstrating professionalism in your audiology
clinic placement.


Please indicate that you have read this memo by signing and dating it and leaving it immediately in
my mailbox. A copy of this memo will be given to the Audiology Clinic Director who will place it
in your clinical file.

___________________________________                 _________________________
Student Clinician                                   Date

__________________________________                  _________________________
Clinic Supervisor                                   Date

C:     Audiology Clinic Director
       Student Clinician
         SCHOOL OF ALLIED HEALTH SCIENCES
                          STUDENT CONDUCT CODE

The University policy (Student Handbook and Academic Year Planner – “Clue Book”) regarding
student conduct states, “students enrolled at ECU are expected to uphold at all times standards of
integrity and behavior that will reflect credit upon themselves, their families, and East Carolina
University”. Additionally, the faculty of the School of Allied Health Sciences (SAHS) have an
academic, legal and ethical responsibility to protect the public and health care community from
inappropriate professional conduct or unsafe behaviors in the practice of Allied Health Professions.

Students will be provided with documents expressing expectations regarding academic and
professional conduct within all academic and clinical aspects of the curriculum during general
advisement sessions, course work, clinical affiliations, and other instructional forums. All SAHS
students are expected to be familiar with their department policies and professional code of ethics
and to conduct themselves in accordance with these standards.


A. DEFINITIONS

    1.   “SAHS Student Conduct Code” or “Student Conduct Code” - School of Allied Health
         Sciences Student Conduct Code.

    2.   “Hearing Committee” - School of Allied Health Science‟s Hearing and Appeals
         Committee. This committee is authorized to review the charges against a student, to
         determine if sufficient evidence exists to warrant a hearing, determine whether a student
         has committed a violation, and recommend any sanction(s).

    3.    “Student Misconduct File” - student file that will be established upon the recommendation
         of the Hearing and Appeals Committee. The file will contain decisions and
         recommendations of the Committee relative to identified conduct violations by the
         individual student. The file is distinct from the student‟s academic file.

    4. “School” - School of Allied Health Sciences (SAHS).

    5. “Department” – respective departments of the SAHS.

    6. “Charged student” - any student who is charged with an alleged conduct violation.

    7. “Student” - any student enrolled in a department of the SAHS.

    8. “Faculty” - faculty members with an appointment in a SAHS department.

    9. “Clinical supervisor” - the professional staff member at the clinical setting assigned to
       oversee the student‟s clinical experience.
     10. “Complainant” - any individual who files a complaint against a SAHS student for
         misconduct.

     11. “Student Handbook” – the most current Student Handbook and Academic Year Planner the
         “Clue Book” of East Carolina University.

     12. “Cheating” - either the attempt or actual giving or receiving of unauthorized aid or
        assistance. This includes, but is not limited to: 1) use of unauthorized assistance during
        exams and quizzes, or 2) utilization of sources beyond those authorized by the instructor in
        writing papers, preparing reports, solving problems, or carrying out other academic material
        belonging to a member of the faculty, staff, or other students.

     13. “Plagiarism” - includes, but is not limited to the use by paraphrase or direct quotation, of
         the published or unpublished work or thoughts of another person without full and clear
         acknowledgement and passing it as one‟s own work.

     14. “Academic days” - any time the student is involved in a regular course sponsored activity
        of the respective SAHS department program.

     15. “Filed violation” – an academic integrity or conduct code violation(s) and accompanying
        sanction(s) that have been submitted to either the Dean of Students, ECU, or the Dean of
        SAHS in accordance with the Policies and Regulations of the Student Handbook.


B.    Proscribed Conduct

      Any student while engaging in university related activities or on university property,
      committing misconduct as described or referred to in this section is subject to the disciplinary
      procedures and sanctions as outlined in this document.

      1. Violation of published Department, School of Allied Health Sciences policies, rules, and
         regulations.

      2. Violation of the East Carolina University Code of Student Conduct (Student Handbook).

      3. Violation of the North Carolina statute for those disciplines for which such statutes exist
         specifically pertaining to the practice of the respective health professions.

      4. Violation of the Code of Ethics or the Standards of Professional Conduct of the respective
         profession.

      5. Acts of dishonesty, including but not limited to the following:

          a. Furnishing false information in an official matter to any member of the faculty, staff,
             or affiliated clinical instructor with the intent to deceive.
       b. Forging, altering, or misusing a Department of School of Allied Health Sciences
          document, record or instrument of identification.

   6. Disruption or obstruction of teaching, research, administration, service delivery, or other
      activities sponsored by the Department, School or affiliated clinical sites, or other
      Department and School sponsored activities.
   7. Verbal and/or physical abuse, threats, intimidation, harassment, coercion and/or other
      conduct which threatens or endangers the health or safety of any person.

   8. Attempted or actual theft or receipt of stolen property and/or malicious damage to property
      belonging to or located on the properties of the University, affiliated clinical sites, or to
      other personal or public property.

   9. Failure to comply with the security practices of the Department, School, University,
      or affiliated clinical sites.

   10. Use, possession, or distribution of alcoholic beverages except as expressly permitted
       by the law and University regulations.

   11. Conduct or language, while at affiliated clinical sites or on the university campus, that
       is disorderly, lewd, indecent, or disruptive and is directed toward a member of the faculty,
      a fellow student, clinical fieldwork personnel or clients, or visitors.

   12. Failure to comply with the implementation of Code of Student Conduct procedures.

   13. Willingly and knowingly during the clinical field placement, delivering clinical services
       that a student is not authorized to perform.

   14. Any behavior which jeopardizes the safety of the student or another individual especially
       if it pertains to the delivery of services and occurs during academic and/or clinical
       activities and field placement.

   15. Violation of civil or federal laws involving the use of alcohol, firearms or the illegal use,
       possession, manufacture, sale or distribution of narcotics and other controlled substances.


C. PROCEDURES

  The policies and procedures prescribed to in this document support and maintain the student‟s
  right of due process and fair hearing in accordance with the university‟s policy and The Code –
  Board of Governors, The University of North Carolina, August 1988.

   1. Academic integrity violation
     Violations of academic integrity as defined in the Student Handbook and in this document
     including cheating and plagiarism will be handled as outlined in the policies and procedures
     for academic integrity violations in the Student Handbook.

     2. Non-academic conduct violations within clinical/field setting.

     The determination that a student can not function appropriately and safely in a clinical
     environment is determined in concert by the supervisor and faculty coordinator considering
     due process, department policy and procedure, and inter-institutional contract.


     3. Non-academic conduct violations within the academic settings.

     Any individual may file a complaint against a SAHS student for misconduct.
     Complaints must be submitted in writing to a faculty member before formal action
     can be initiated. Breach of professional conduct should be discussed with the
     student by the respective faculty member and reported to the department chair. In
     the event that the faculty member is the department chair, the Associate Dean of
     SAHS may conduct the inquiry. Communications and information regarding conduct
     violations are to be kept confidential.

     The department chair will conduct an inquiry to determine if the charges have merit and
     warrant further investigation. Upon completion of such investigation, the department chair
     may request that the Hearing Committee initiate a „misconduct hearing process‟. The written
     complaint and all available information gathered as a result of the inquiry will be provided to
     the Hearing Committee by the department chair.

     4. Violations that may result in the immediate and temporary removal of a student from an
        „in progress‟ department educational activity.

     Any instructor of a SAHS program sponsored educational activity may temporarily remove a
     student from an activity that is „in progress‟ for any of the prescribed conduct violations
     considering due process, department policy and procedure, and inter-institutional contract.

     If the student is removed from a classroom academic setting, the department chair or
     designee is notified immediately of the incident. Depending upon the nature of the
     infraction, the department chair may request that the student be removed from the remaining
     classes of the day. Removal of a student from an „ in progress class‟ may result in a formal
     misconduct charge. Conduct which jeopardizes the safety of others in an actual or simulated
     clinical setting may result in removal from the activity and suspension of the remaining
     clinical experience (see sections B and C2).

D.    The Hearing Process

     1.   The Hearing Committee will be the SAHS Hearing and Appeals Committee.
2.   A written charge is filed by the Department Chair with the Hearing Committee. The
     Department Chair will forward an investigative report, supporting documents, and a
     recommendation of appropriate sanction to the Committee. The Hearing Committee will
     conduct a primary interview with the charged student for the purpose of presenting the
     charges to the student and allowing the student the opportunity to respond to the
     allegations. The primary interview will be conducted in accordance with policies
     utilized for academic integrity issues (see Clue Book, Policies and Regulations) and the
     student may choose to be accompanied by a non-participating observer.

3.   Following the primary interview, the Hearing Committee will decide by majority vote
     whether there is sufficient evidence of a violation to warrant a formal hearing. The
     Hearing Committee must communicate its decision to the student within two (2)
     academic days following the primary interview. Possible recommendations of the
     Hearing Committee are as follows:

     a.   Sufficient evidence to support a violation does not exist. Such a disposition will be
          final and there shall be no subsequent proceedings regarding the alleged violation.

     b.   Sufficient evidence of a violation does exist and the violation is severe enough to
          warrant a formal hearing. In this case, a hearing will be established within five (5)
          academic days following notification of the student.

     c.   All parties (student, Department Chair/Director, and Committee) concur that
          additional testimony is not required and that the recommended sanctions are
          appropriate. Prior to such a recommendation, the student must agree that a
          violation has occurred, concur with the sanction recommended by the Department,
          and waive (in writing) the right to present additional evidence and testimony at a
          formal hearing.

4.   Hearings shall be conducted in accordance with the following guidelines:

     a.   Confidentiality of the proceedings shall be maintained at all times.

     b.   A verbatim transcript of the proceedings shall be maintained at all times.

     c.   The hearing shall be conducted and controlled by the chair of the Hearing
          Committee.

     d.   Admission of any person to the hearing shall be at the discretion of the Hearing
          Committee.

     e.   The complainant(s) and charged student may have the opportunity to present
          witnesses, to examine and cross-examine witnesses, and to have a non-
          participating observer present. The Hearing Committee has the right to examine
          and cross-examine witnesses brought to testify relative to the alleged violation.
                The non-participating observer will not be allowed to officially participate in the
                proceedings.

           f.   Pertinent records, exhibits and written statements may be accepted as evidence for
                consideration by the Hearing Committee.

           g.    All procedural questions are subject to the final decision of the Hearing Committee
                 Chair.
                 .
      5.   After the hearing, the Hearing Committee shall decide by majority vote if the relevant
           evidence was adequate to support the conclusion that the student violated the Student
           Code of Conduct. The committee‟s determination shall reflect that the decision is based
           on the facts of the case and it is not arbitrary, capricious, or discriminatory.

      6.   The chair of the Hearing Committee will submit a written statement of its findings
           complete with sanction recommendations to the Dean of the SAHS, within two academic
           days following closure of the hearing.


      7.   The Dean of the SAHS will determine final action and will give written notice within
           five academic days to the Hearing Committee, the student, and the department chair.

      8.   The Hearing Committee conduct code proceedings are conducted independently
           of other hearings and proceedings that may result from the alleged violations.

      9.   If the violations(s) were also violations of the university conduct code then the Hearing
           Committee may recommend forwarding all proceedings to the University Dean of
           Students for consideration.

E.   SANCTIONS:

     The Hearing Committee may recommend any one or combination of the below listed
     sanctions as deemed appropriate for the violation. Disciplinary sanctions excluding dismissal
     from the program will not become part of the student‟s academic record but kept in a separate
     “student misconduct file”. The student misconduct file will be kept in the office of the Dean,
     SAHS. Upon graduation, the student misconduct file will automatically be expunged.

     1.    Warning – A written notice to the student and the creation of a Student Misconduct File
           containing the decisions and actions of the Hearing Committee and the department.

     2.    Probation – In addition to a written reprimand to the student and the creation of a
           misconduct file, the student is placed on conduct probationary status for a defined period
           recommended by the department. During the probationary period, the occurrence of
           another conduct violation will be sufficient grounds for dismissal from the program.
     3.   Specific conditions – Specific conditions may be recommended singularly or in
          conjunction with other sanctions. Specific conditions such as professional evaluations,
          counseling and other forms of assistance designed to improve and maintain the health,
          safety and well being of the student may be recommended.

     4.   Loss of Privileges – As recommended by the department.

     5.   Restitution – Compensation for loss, damage , and/or injury as a result of the violation.
          Restitution may be in the form of monetary or material replacement.

     6.   Dismissal from the program. The student may reapply for competitive readmission for
          the next academic cycle.

F.   Appeals

     1.   Academic Integrity Violations

          Appeals of academic integrity violations are directed to the Dean of Students and the
          Academic Integrity Board of the university and follow the appeal process and
          procedures described in the Student Handbook.


     2.   Student Conduct Code Violations

          All appeals must be written, outlining the specific grounds for the appeal and submitted
          to the Vice Chancellor for the Division of Health Sciences within three (3) academic
          days following notification. Appeal decisions must be reported to the student in writing
          within five academic days following the appeal request. Except for the consideration of
          new evidence, an appeal will be limited to the review of the verbatim record of the
          Hearing Committee hearing and supporting documents.

          The decision of the Vice Chancellor, Division of Health Sciences is final.

Approved by the majority of the SAHS voting faculty: 05/03/00
Reviewed by Gary Vanderpool: 06/28/00
Adopted: 06/29/00
Appendix B

   Audiology Session Sequence
   Audiology Protocols
   Audiology Procedures
   Sample Reports
   Hepatitis B Vaccination/Declination
   HIPAA Requirements
   Infection Control Plan
   Sterilization Plan
   Clinical Feedback Form
   Clock Hour Form
   Clinical KASA Form
   FERPA Memorandum
   Student Confidentiality Statement
   Student Accommodations
                         Typical Sequence for Seeing an Audiology Client
                         in the ECU Speech-Language & Hearing Clinic

1. Check the Audiology Appointment book for the clients and types of appointments 24 hours in
advance of that appointment block.

2. The “Request for Services” intake information/client folders typically will be at the front desk.
Ask the front desk if you may scan the information available.

3. Return information to the front desk.

4. Advise your supervisor as to the age of clients, special needs or issues, and the types of
appointments scheduled. You should communicate with your supervisor prior to the actual
appointment day but speak with him/her about the timing of this communication. You and your
supervisor may discuss the types of procedures likely to be performed and the need for you to
review procedures or readings in advance.

6. Arrive at the Audiology Clinic at least 15 minutes prior to your session when possible and
perform equipment checks (audiometer, immittance meter, DPOAE meter).

7. Prior to greeting the client on the appointment day, advise your supervisor that you are ready to
begin the audiology session. S/he will indicate when you are to bring the client back into the clinic
and begin your session.

8. Wash your hands prior to seeing the client.

9. Greet the client and if applicable ask if significant others would like to come back or remain in
the waiting room until the end of the session.

10. Begin with the completion of the HIPAA forms and the case history interview unless prior
forms are still in the file and within the release dates. Remember that you are responsible for
obtaining all addresses for reports that are to be mailed out so ask clients if they are able to provide
addresses to save time searching later.

11. Complete audiology procedures, as directed and supervised by your supervisor. Your supervisor
will indicate when all needed procedures are completed.

12. Consult with your supervisor regarding the end of session counseling and recommendations.

13. Your supervisor will check off the audiology CPT procedures, ICD-9 codes, cross-link the two,
sign the bill and direct the client to present that bill to the front desk.

14. Escort the client back to the front desk and have them present the bill to the front office staff
who will collect the fees.

15. Wash your hands.
16. If you have finished seeing all of your clients for the day and you are the last clinical team, then
clean up the Audiology Clinic (tips and papers) and turn off equipment.

17. Discuss the needed documentation for that clinical session with your supervisor. If a typed
report is requested then it should be completed within CSDI (not off of the premises) and
submitted to your supervisor no more than 48 hours after the appointment. Please discuss the
process of reporting/documentation with your supervisor.

18. Revised reports should be returned to your supervisor within 24 hours. Once your report is
finalized then the supervisor will insure that appropriate signatures are obtained and place the report
and file in the front office for the copying and mailing of the report.

19. If you have any questions about the clinical session or client or documentation, please ask your
supervisor or Dr. Culbertson. We are here to help you learn.
                       AUDIOLOGICAL PROTOCOLS

  I.      Adult Hearing Evaluation
  II.     Auditory Evoked Potentials
  III.    (Central) Auditory Processing
  IV.     Cochlear Implant Candidacy
  V.      Cochlear Implant Activation and Orientation
  VI.     Hearing Aid Evaluation
  VII.    Hearing Aid/Cochlear Implant Check/Follow-up
  VIII.   Hearing Aid Fitting & Orientation
  IX.     Industrial Hearing Conservation Evaluation
  X.      Pediatric Evaluation
  XI.     ROTC Evaluation
  XII.    Speech Easy Evaluation
  XIII.   Vestibular Evaluation

I. Adult Hearing Evaluation
            Case History
            Otoscopy
            Tympanometry
            Acoustic Reflex Threshold Testing
            Pure Tone Air Conduction Thresholds
            Pure Tone Bone Conduction Thresholds
            Clinical Masking for Pure Tones
            Speech Recognition Thresholds
            Supra-threshold Speech Recognition
            Clinical Masking for Speech
            Other testing indicated
            Follow-up Counseling and Recommendations

II. Auditory Evoked Potentials
           Case History
           Otoscopy
           Tympanometry
           AEP Measures
           Follow-up Counseling and Recommendations
III. (Central) Auditory Processing Evaluation
            Case History
            Otoscopy
            Tympanometry
            Acoustic Reflex Measures (thresholds or
            screen)
            Pure Tone Air Conduction Thresholds
                      Test(s) of Auditory Closure
                      Test(s) of Binaural Integration
                      Test(s) of Binaural Separation
                        Test(s) of Auditory Temporal Patterning
                        Test(s) of Auditory Temporal Resolution
                      Test(s) of Binaural Interaction
            Follow-up Counseling and Recommendations

  IV. Cochlear Implant Candidacy
          Under Construction

  V. Cochlear Implant Activation and Orientation
          Under Construction

  VI. Hearing Aid Evaluation
          HAE Case History
          Review audiogram & implications of hearing loss for everyday
          communication
          Hearing Aid Expectations and Pre-Benefit Measures
          Introduce different styles of hearing aids
          Discuss different types of circuitry
          Introduce client to assistive listening devices
          Discuss medical consent/waiver
          If client decides to try amplification, complete otoscopy before
          impressions
          Take ear impressions & process order
          Offer client hearing aid informational materials
          Schedule or discuss scheduling of orientation & fitting
VII. Hearing Aid/Cochlear Implant Check up/Follow-up
        Listen to client report of concerns/issues
        Ask appropriate follow-up questions to further understand problem(s)
        Adjust programming of the hearing aid/CI and discuss changes made
        Take client outside clinic room so that s/he can listen to changes in a
        different environment
        Make sure changes are saved to hearing aid/CI and to computer before
        client leaves

VIII. Hearing Aid Fitting and Orientation
        Review hearing aid/earmold information before client arrives
        If hearing aid(s) is/are programmed on Noah, have hearing aid(s)
        connected with appropriate cords and software pulled up
        Complete otoscopic examination
        Try hearing aids on checking for appropriate fit and comfort
        Conduct probe tube measurements to adjust & approximate prescribed
        settings
        Adjust hearing aid(s) to achieve acceptable volume & sound quality
        Save programming adjustments into hearing aid(s) & Noah database
        Counsel client on hearing aid components, care and use of hearing aid(s)
        Schedule follow-up appointment

IX. Industrial Hearing Conservation Evaluation
      a. Case History (questioning noise exposure history and work history)
      b. Otoscopy
      c. Tympanometry
      d. Acoustic Reflex Threshold Testing
      e. Pure Tone Air Conduction Thresholds
      f. Pure Tone Bone Conduction Thresholds
      g. Clinical Masking for Pure Tones
      h. Speech Recognition Thresholds
      i. Supra-threshold Speech Recognition
      j. Clinical Masking for Speech
      k. Other testing indicated
      l. Follow-up Counseling and Recommendations
      m. Report using OSHA guidelines
X. Pediatric Evaluation
       Case History
       Otoscopy---may conduct at end of session
       Tympanometry---may conduct at end of session
       Acoustic Reflex Measures (thresholds or screen)---may conduct at end
       of session
       Visual Reinforcement Audiometry or Conditioned Play Audiometry
       Speech Recognition Thresholds (age appropriate materials)
       Supra-Threshold Word Recognition (age appropriate materials)
       Other tests indicated
       Follow-up Counseling and Recommendations

XI.   ROTC Screening
        Case History that is on ROTC Form
        Otoscopy
        Pure Tone Air Conduction Thresholds 500-6000 Hz
        Results are not discussed with client but offered by Concorde

XII. Speech Easy Evaluation
       Otoscopy
       Tympanometry
       Pure tone Air Conduction Thresholds
       Pure Tone Bone Conduction Thresholds (if hearing loss is noted)
       Impression(s) of ear selected for device use

XIII. Vestibular Evaluation
         Case History
         Otoscopy
         Tympanometry
         Hearing Evaluation
         Rotary Chair
         ENG protocol
         Follow-up Counseling and Recommendations
                AUDIOLOGICAL PROCEDURES

Case History
Otoscopy
Tympanometry
Acoustic Reflex Testing
Pure tone air and bone conduction testing
Clinical masking for air and bone conduction
Speech Audiometry
Speech Recognition Threshold
Speech Detection Threshold
Clinical Masking for SRT and SDT
Supra-Threshold Word Recognition
Clinical Masking for Supra-Threshold Word Recognition
Visual Reinforcement Audiometry
Conditioned Play Audiometry
(Central) Auditory Processing
Probe Tube/Real Ear Measures
Aided Soundfield Testing
Electroacoustic Measurements
Hearing Aid Visual Listening Check
Transient and Distortion Product Otoacoustic Emissions
Auditory Evoked Potentials
Neurological evaluation
Estimated threshold evaluation
Vestibular Evaluation
Case History
  1. Identifying information
        a. Name, address, telephone number
        b. Sex, age
        c. Referral source
  2. Purpose of referral and presenting complaint
  3. Audiological history
        a. Onset: date, sudden or gradual, to what onset was related
        b. Better ear
        c. Unilateral or bilateral loss
        d. Stable, progressive, or fluctuating loss
        e. Family history of hearing impairment
        f. Exposure to noise: military, industrial, recreational, environmental
        g. Medications: prescription or nonprescription
        h. Previous hearing tests
        i. Head trauma or accidents
  4. Communication history
        a. Situations in which hearing difficulties are noticed; e.g., difficulty
            hearing
            men‟s, women‟s, children‟s voices; Difficulty localizing; Difficulty in
            noise;
        b. Use of amplification
        c. Speech-language therapy or evaluation
        d. Communication needs: retired, live alone, recreational interests
  5. Otologic history
        a. Previous ear, nose or throat surgery
        b. Ear pain
        c. Ear discharge
        d. Tinnitus: unilateral or bilateral, continuous or fluctuating, onset,
            characteristics (buzzing, hissing, thumping, ringing, rushing, steam,
            high-pitched, low-pitched, roaring), frequency, degree of severity
        e. Dizziness: characteristics (lightheadedness, faintness, giddiness,
            unsteadiness, spinning-room or within oneself), date of onset, gradual or
            sudden onset, episodic or constant, frequency, duration, associated
            symptoms (nausea, vomiting, sweating, hearing impairment, tinnitus, ear
            fullness, ear pain, ear drainage, gait disturbances, imbalance, visual
            problems), exacerbating and remitting factors (head turn, lying down,
            sitting down, standing up, walking in the dark), precipitating factors,
            alleviating factors, dysarthria, blackouts
        f. Ear infections
   6. Medical history
        a. General health
        b. Kidney disease
        c. Cancer
        d. Diabetes
        e. Hypertension
        f. Other vascular or cardiac problems
        g. Other diseases: measles, mumps, chicken pox, meningitis, syphilis,
           tuberculosis, malaria, scarlet fever, AIDS, thyroid disease
        h. History of smoking
        i. History of alcohol
        j. Allergies
        k. Visual problems: night blindness, tunnel vision, diplopia, blurring,
           corrective lens
        l. Sinus problems
        m. Seizures
        n. Neurologic or neuromuscular problems
        o. Bone disease
        p. Native language
        q. Head and neck defects
        r. Psychologic or psychiatric therapy or counseling
        s. Financial information (Medicaid, unemployed, receiving disability)

Additional information for Children:
  1. Prenatal history
        a. Ototoxic medications
        b. Maternal diseases
        c. Rubella immunization
        d. Spontaneous abortions or miscarriages
  2. Perinatal history
        a. Congenital infections
        b. Low birth weight
        c. Hyperbilirubinemia
        d. Asphyxia
        e. Congenital cranio-facial abnormalities
  3. Developmental history
        a. Speech-language milestones
        b. Motor milestones
        c. Auditory milestones
4. Educational history
     a. Special education
     b. Special education assistance
     c. Repeated grades
     d. School performance
     e. Learning disabilities
     f. Psychoeducational evaluations
     g. Mental retardation
Otoscopy

There are several types of otoscopes available in the clinic, including the following:
Diagnostic otoscope, Macroview otoscope, video otoscope, pneumatic otoscope, and
operating otoscope.

Procedure:
  1. Hands should be washed and gloves worn, as needed.
  2. Look first at the pinna, head, and neck for abnormalities.
  3. Look at the opening to the ear canal and choose the largest clean speculum that
     would fit comfortably.
  4. Rotate the specula firmly onto the head of the otoscope and switch on the light.
  5. Wrap bottom three fingers and the thumb around the handle. Leave the index
     finger free to stabilize your hand against the client‟s hand. Otherwise you
     could stab the client with the speculum tip.
  6. Hold the otoscope firmly and place viewing head with attached speculum in the
     opening to the ear canal.
  7. If you are looking in an adult‟s ear pull slightly up and back on the pinna with
     your other hand. If you are looking in a child‟s ear the canal will either be
     straight or angle down slightly, you may pull slightly down on the pinna.
  8. Now put your eye to the viewing head and slightly turn the otoscope until you
     can see the full viewing area.
  9. Note the following:
         a. ear canal skin coloration and condition; normal or describe (e.g., mass,
            discharge, swelling)
         b. cerumen accumulation:
            1. less than 50%, non-occluded;
            2. 50 to 80%, excessive;
            3. >80%, impacted.                       Ballachanda, 1995
         c. tympanic membrane coloration and condition: normal or describe (e.g.
            red, yellow, bulging, possible perforation, presence or PE tube). If
            unable to visualize the TM, then that should be reported.
    Tympanometry

       Low Frequency
          Place tympanometric probe in test ear, obtain seal and run tympanogram.
          In individuals of four months or older, low frequency tympanograms are
          usually measured & data for those measures is found in the table below.

             Perform acoustic reflex measures for that probe ear after each
             tympanogram is obtained. After obtaining the right tympanogram, for
             example, measure the right ipsi and left contra reflexes.


                                              Norms for Tympanometry
Age group                      Y               TW        Vea   Res F SF Res F SP
                             (mmho)           (daPa)    (cm³)     (Hz)      (Hz)
                Mean           0.52 *ª          114ª           0.58◦          1153ª          1041ª
Children        90%            (0.25-         (80-159)ª      (0.3-0.9)◦        (850-          (755-
(3-10 y)       Range           1.05)*ª          ≥160            ≥1.0          1525)ª         1425)ª
                Fail            ≤0.2*                                        <850Hz         <755Hz
               Criteria         ≤0.3†                                        >1525Hz        >1425Hz
                Mean           0.79 *◦           77c           1.36e          1135b            990b
  Adult         90%            (0.30-         (51-114)c      (0.9-2.0)e        (800-          (630-
 (≥18 y)       Range           1.70)◦           ≥115            ≥2.0          2000)b         1400)b
                Fail            ≤0.3*                                        <800Hz         <630Hz
               Criteria         ≤0.4†                                        >2000Hz        >1400Hz
 Norms for static admittance (Y), tympanometric width (TW), equivalent ear canal volume (Vea), and resonant
 frequency (Res F) determined from sweep frequency (SF) and sweep pressure (SP) methods
 Hunter (1993), Margolis and Goycoolea (1993); Margolis and Heller (1987); Shanks et al (1992); Wiley et al (1996).

 VanHuyse Model for Interpreting High Frequency Tympanograms
       (e.g., 660 or 678 Hz probe frequency) Vanhuyse et al. (1975)

*High frequency tympanometry is not routinely used when evaluating adults

Record susceptance (B) and conductance (G) tympanograms using a 660 or 678 Hz
probe frequency.

Identify the number of positive and negative peaks on the B/susceptance
tympanogram, and on the G/conductance tympanogram.
Tympanograms suggesting normal middle ear function:
1B1G
3B1G but may also be seen with monomeric eardrums and tympanosclerosis
3B3G but may also be seen with eardrum pathology and ossicular discontinuity
5B3G but may also be seen eardrum pathology and ossicular discontinuity

Van Camp et al. (1986) suggested that the following conditions must be met for
tympanograms to be considered normal:
   1. the pressure range encompassing the outermost peaks on the G tympanogram
      must not exceed the pressure range for the outermost peaks on the B
      tympanogram (by more than 75 daPa in 3B3G tympanograms and by more
      than 100 daPa in 5B3G tympanograms),
   2. the number of peaks must not exceed 5 for the susceptance (B) tympanogram
      and must not exceed 3 for the conductance (G) tympanogram;

Abnormal 678 (660 Hz) Tympanograms: too wide OR too many peaks
Abnormal 678/660 Hz that are too wide/shallow: middle ear fluid
Abnormal 678 (660 Hz) with excessive peaks: usually associated with ossicular
discontinuities, but may be seen with other TM abnormalities (monomeric/dimeric
TM)

*Remember that ossicular discontinuities will also impact hearing and ARTs

High Frequency Tympanometry Norms for Infants


 Under construction
Acoustic Reflex Thresholds

  1. Most tympanometers will re-pressurize to the stored tympanometric peak
     pressure so you will need to run a tympanogram before obtaining the related
     ARTs for that probe ear (e.g., right tympanograms before right ipsi and left
     contra ARTs).
  2. The compliance scale setting for measuring ARTs is extremely sensitive
     because the AR compliance change is small so watch for artifact (i.e.,
     recordings that do not have the expected shape, that are not time-locked to the
     stimulus, or that are time-locked to client movement, talking, chewing, and
     coughing).




  3. The ART search can be started at 70 dB HL ascending in 5 dB steps; or can be
     started at 85 dB HL (i.e., median ART) and drop to the 70 dB HL starting level
     if an ART is present at 85 dB HL and ascend thereafter.
  4. ARTs are typically tested at 500, 1000, 2000 Hz (Gelfand, Schwander, &
     Silman, 1990). Gelfand et al. offer data on the highest expected ARTs levels
     for a given degree of hearing loss at these three frequencies. Their data is
     intended for use with normal hearing or sensorineural hearing loss. ARTs are
     expected to be elevated or absent with conductive involvement. Some
     individuals with normal hearing have absent ARTs at 4000 Hz limiting the
     diagnostic significance of ARTs at this frequency.
  5. The Ipsilateral ARTs may be called Right Ipsilateral or Stim R/Probe R and
     Left Ipsilateral or Stim L/Probe L measures or Uncrossed Reflexes.
  6. The Contralateral ARTs may be called Right Contralateral or Stim R/Probe L
     and Left Contralateral or Stim L/Probe R measures and are always named for
     the stimulus ear. These ARTs are also called the Crossed Reflexes.
Clinicians are expected to know common ART patterns, for example:
      Unilateral conductive hearing loss with OME (right side):
            Right ipsi: absent or elevated
            Left ipsi: expected levels based on hearing
            Right contra: absent or elevated
            Left contra: absent or elevated
      Cochlear hearing loss of greater than 60 dB HL in both ears:
            Right ipsi: at least 15 dB SL or absent
            Left ipsi: at least 15 dB SL or absent
            Right contra: at least 15 dB SL or absent
            Left contra: at least 15 dB SL or absent

     Auditory nerve pathology (e.g., right side):
          Right ipsi: absent or elevated
          Left ipsi: expected levels based on hearing
          Right contra: absent or elevated
          Left contra: expected levels based on hearing
Acoustic Reflex Decay




    1. The changes in compliance with the AR should be sustained for low
       frequency stimulus tones.
    2. The compliance change should be sustained for 10 seconds.
    3. Acoustic reflex decay is evaluated at 500 and 1000 Hz.
    4. The AR decay stimulus intensity level is set at 10 dB SL re the associated
       ART (i.e., 10 dB SL re the Ipsi ARTs at 500 and 1000 Hz if measuring Ipsi
       AR Decay) and the tone is presented for 10 seconds.
    5. Examine the magnitude of the tracing for 50% or more decay from the initial
       magnitude of compliance change (may need to measure the initial compliance
       change and the final compliance change).
    6. If there is negative AR Decay (no significant decay) then this contraindicates
       retrocochlear or facial nerve involvement.
    7. If there is positive AR Decay (significant decay) then this suggests possible
       retrocochlear or facial nerve involvement depending upon the stimulus
       conditions that result in AR decay.
Pure tone air and bone conduction testing

     Use either Familiarization A or B.

     Familiarization A
     Present a 1000-Hz tone at a 30 dB hearing level (HL). If a clear response
     occurs, begin threshold measurement. If no response occurs, present the tone at
     50 dB HL and at successive additional increments of 10 dB until a response is
     obtained.

     Familiarization B
     Begin at the minimum audiometer hearing level. Gradually increase the level
     of the continuous signal until a response is first detected. Turn off tone for 2
     seconds and then present the tone again at the same level. If a response occurs
     continue with obtaining threshold. If a response does not occur repeat the
     familiarization procedure.

     Threshold Search
     The level of each succeeding presentation is determined by the preceding
     response. After each failure to respond to a signal, the level is increased in 5-
     dB steps until the first response occurs. After the response, the intensity is
     decreased 10 dB, and another ascending series is begun.

     Threshold of hearing. Threshold is defined as the lowest decibel hearing level
     at which responses occur in at least one half of a series of ascending trials. The
     minimum number of responses needed to determine the threshold of hearing is
     two responses out of three presentations at a single level (American National
     Standards Institute, 2004a).

     Continue testing at 2000, 3000, 4000, 6000, and 8000 Hz. (Testing at 3000 and
     6000 Hz is optional but is important when hearing loss is present at any
     adjacent frequency or when noise exposure or hearing aid use is an issue).
     After 8000 Hz is tested, 1000 Hz is tested for test-retest reliability and then
     threshold is established for 250 and 500 Hz.

     When a low frequency hearing loss exists, the hearing threshold at 125 Hz
     should also be measured. When a difference of 20 dB or more exists between
     the threshold values at any two adjacent octave frequencies from 500 to 2000
     Hz, interoctave measurements should be made.
Clinical Masking for Air and Bone Conduction (Martin and Clark, 2000)

     When evaluating air conduction thresholds, determine the minimum interaural
     attenuation for the transducers that are used.

     Masking is needed when the pure tone air conduction threshold of the test ear
     exceeds the pure tone bone conduction threshold of the non test ear by 40 dB
     or more for supra aural headphones and 65 dB or more for insert earphones.

     When evaluating bone conduction thresholds, the unmasked air conduction
     thresholds of the test ear are compared with unmasked bone conduction
     thresholds of the same ear. Masking is needed if the difference between the
     unmasked air conduction thresholds and the unmasked bone conduction
     thresholds are greater than 10 dB.

     Determining initial masking levels for air conduction
          Masking that is introduced into the non test ear will be the air conduction
          threshold of the non test ear plus a 10 dB safety factor. After initial
          masking levels are determined a plateau needs to be established. (See
          below for plateau procedure)

           AC te – IA ≥ BC nte
           IEM = AC nte + 10 dB SF

     Determining initial masking levels for bone conduction
          Masking for bone conduction can be influenced by the occlusion effect.
          The occlusion effect values are added to the masking levels whenever
          pure tone bone conduction threshold testing is performed at the
          frequencies of 250, 500 and 1000 Hz, where the OE is 30, 20 and 10 dB
          respectively. The starting level should be the threshold of the non test ear
          plus the safety factor (10 dB) plus the occlusion effect.

           AC te – BC te > 10 dB
           IEM = AC nte + 10 dB SF + OE
Plateau Procedure
      After obtaining initial masking levels, reestablish threshold in the test ear
      with this initial amount of masking in the non test ear. Each time the
      client responds to the pure tone signal presented to the test ear, increase
      the masking presented to the non test ear by 5 dB. If the client does not
      respond to the tone presented to the test ear, increase the signal in 5-dB
      steps until the client again responds. Continue the procedure until the
      masking can be increased three consecutive 5 dB steps without
      producing a shift in the threshold level of the test ear. This is considered
      the plateau. Record masked threshold and final masking level.

      If no plateau is obtained check for overmasking using formula:

      Masker level – IA ≥ BC te

      If answer is no, then record threshold at final pure tone level using
      masked symbol with arrow indicating that the threshold is beyond that
      level..

      If answer is yes, then asterisk the unmasked threshold and note below
      that overmasking occurred and an accurate masked threshold could not
      be obtained.
Speech Recognition Threshold (SRT) & Speech Detection Threshold
     (SDT) Testing

Martin and Dowdy procedure
 a. Choose at least 6-8 spondees (to minimize the impact of chance) and
    familiarize the listener with the spondaic words to be used.
 b. Set the starting level at 30 dB HL. Present one spondee. If a correct
    response is obtained, this suggests that the word is above the client‟s
    SRT.
 c. If no correct response is obtained, raise the presentation level to 50 dB
    HL. Present one spondee. If there is no correct response, raise the
    intensity in 10 dB steps, presenting one spondee at each increment. Stop
    at the level at which either a correct response is obtained or the limit of
    the equipment is reached.
 d. After a correct response is obtained, lower the intensity 10 dB and
    present one spondee.
 e. When an incorrect response is given, raise the level 5 dB and present one
    spondee. If a correct response is given, lower the intensity 10 dB. If an
    incorrect response is given, continue raising the intensity in 5 dB steps
    until a correct response is obtained.
 f. From this point on the intensity is increased in 5 dB steps and decreased
    in 10 dB steps, with one spondee presented at each level until three
    correct responses have been obtained at a given level.
 g. Threshold is defined as the lowest level at which at least 50 percent of
    the responses are correct.
      ASHA 1988 2-dB SRT Procedure:


Familiarization stage: Review test spondees and remove words that client is
unable to identify


Descending Threshold determination:
1. Start at 30 to 40 dB above PTA and present one spondee, if not identified
correctly go up in 20 dB steps until a spondee is correctly identified.
2. Once spondee is correctly identified, drop in 10 dB steps with one spondee at
each level until a level is reached where the spondee is missed and present a
second spondee at that level. If the second spondee is missed move to step 3, if
not descend in 10 dB steps until two spondees are missed at a level.
3. Go up 10 dB to the "Starting level" for threshold testing.


Speech Recognition Threshold Test Phase: 2 dB steps
1. Present two spondees at starting level & at each successive 2 dB decrement.
2. Continue to #3 only if 5 of first 6 words are correctly identified, otherwise raise
the starting level by 4-10 dB and begin test phase again.
3. Stop testing when client responds incorrectly to 5 of last 6 words presented.


Threshold is calculated:
SRT = starting level - # correct (from starting level to stopping level) + 1
(correction factor; Spearman-Karber formula for estimating 50% identification).


Example of record keeping and SRT calculation:
Client PTA = 20 dB HL, Clinician starts at 40 dB SL or 60 dB HL
60   +      (no need for second word)
50   -   -   (second word given and missed go up 10 dB to starting level)
Starting level: 40 dB HL
40   +   +
38   +   +
36   +   -
34   +   +
32   -   +
30   +   -
28   -   -
26   -   -                 Stop because 5/6 last words are incorrect
Calculate SRT = 40 - 9 + 1 = 32 dB HL
                  Start level - # correct + 1 = SRT
Clinical Masking for Speech Recognition Threshold (Martin and Clark, 2000)

SRTte – IA ≥ BBCnte
IEM = SRT nte + 10 dB SF + largest ABG nte

Present an initial level of effective masking to the non test ear and spondees at the
unmasked SRT level to the test ear. Attempt to raise masker to achieve a 15-20 dB
plateau.

Speech Detection Threshold (SDT or SAT)

The SDT requires that the client signal the presence of speech (speech babble,
running speech, spondees). The client is not required to repeat or identify speech, but
simply raise a hand or indicate that s/he hears a voice. ASHA guidelines suggest that
the methods used for pure tone threshold testing be applied to obtain the SDT.
Supra-Threshold Word Recognition/Identification

Word lists available: CID W-22, NU6, NU-CHIPS, WIPI , PBK

Monosyllabic words may be administered by using monitored live voice or recorded
materials (preferred method). After establishing the SRT one typically presents the
monosyllabic word lists at 30-40 dB above the SRT. If the client states that the level
is too loud or too soft then the level is adjusted accordingly. The client is asked to
repeat the words and if needed guess at each of the words presented.

While word lists typically include 50 words, many clinicians use half-lists of 25
words to obtain a percent correct word recognition score. Longer word lists result in
more accurate and more stable scores; however, at the cost of longer administration
time. The SPRINT chart (Thibodeau, 2000) may be used to interpret scores for NU-6
half lists or whole lists.

To create a performance-intensity (PI) function, one can measure the client‟s
maximum speech understanding by assessing performance at various intensity levels,
in steps beginning near but above threshold and continuing to intensity levels that are
well above threshold. For efficiency, clinicians often will use two levels: 1) 30-40 dB
SL re the SRT; and 2) an extremely loud level of 80-90 dB HL in order to rule out
rollover.

Clinical Masking for Supra Threshold Word Recognition

PLte – IA > BBCnte
Masking level = PLte – IA + 10 dB SF + largest ABGnte

Whenever masking is needed during SRT testing, it will always be needed for supra
threshold word recognition testing for the same ear. Determine the level of masking
to be used. Start the masking signal in the non test ear and continue with the word list
presentation to the test ear.
Visual Reinforcement Audiometry

VRA testing is completed in a sound-isolated test booth, usually with the child sitting
in a parent‟s or guardian‟s lap or in a high chair facing directly forward. A clinical
test assistant quietly keeps the child occupied with the use of books or toys. To
condition the child, a stimulus (word, warble tone, narrowband noise) is presented
well above the suspected threshold from a loudspeaker. If the child spontaneously
offers a head turn response then a visual reinforcer is paired with the sound
presentation. Initially, it may be necessary for the test assistant to point out the sound
and reinforcer, “We heard the bear”. But a conditioned response from the child (not
initiated by the assistant) must be obtained before an attempt to search for thresholds
or minimal response levels.

When the child is conditioned to respond to the sound stimulus, then the tester may
attempt a threshold search for that sound presented through each loudspeaker. These
threshold estimates should be within 15 dB of one another.

Speech detection thresholds can also be established using the above procedure and
live voice presentation of the child‟s name and/or nonsense syllables.

If a child is successfully conditioned to respond to soundfield presentations, then
ideally the clinician will attempt to measure individual ear thresholds under
earphones with visual reinforcement offered on the side of the ear receiving the
stimuli.
Conditioned Play Audiometry

Pure tone threshold testing should be conducted through supra aural headphones or
insert earphones whenever possible. Sound field (loudspeaker) presentations may be
used if the child will not tolerate headphones or inserts.

The clinician chooses several activities (putting dinosaurs or blocks into a bucket,
placing pegs onto a board, etc.) to switch to quickly if the child loses interest. For
young children below the age of four, the clinician offers a block and verbally
instructs the child to “put it in the bucket”. If the child is able to wait and do so on
command, then advise that now a “birdie” will tweet and ask him/her to put it in the
bucket. The clinician makes a tweet sound and determines if the child is able to
respond only when the tweet sound is made, i.e., the child is conditioned.

When the child is conditioned, the clinician obtains thresholds at 2000 and 500 Hz in
and then in the other ear. Then testing continues with 1000 and 4000 Hz. If the child
continues to respond reliably thresholds for 250 and 8000 Hz can be obtained.
(Central) Auditory Processing

(Central) auditory processing disorder [(C)APD] refers to difficulties in the
processing of auditory information in the central nervous system (CNS) as
demonstrated by poor performance in one or more of the following skills:
      sound localization and lateralization;
      auditory discrimination;
      auditory pattern recognition;
       temporal aspects of audition, including
             temporal integration,
             temporal discrimination (e.g., temporal gap detection),
             temporal ordering,
             and temporal masking;
      auditory performance in competing acoustic signals (including dichotic
      listening); and
      auditory performance with degraded acoustic signals. (ASHA, 2005)

**Other information for CAP comes from Bellis, T.J. (2003) Assessment and
Management of Central Auditory Processing Disorders in the Educational
Setting: From Science to Practice. 2nd Ed. Delmar Learning

A two channel audiometer is needed for (central) auditory processing testing.
Clinicians should monitor only one channel at a time and keep track of which ear the
monitored channel is routed to in order to reduce scoring errors.

It is recommended that these tests only be administered to persons with bilateral
symmetrical hearing sensitivity.

Dichotic Listening Tests

The presentation of stimuli to both ears simultaneously, with the information
presented to one ear being different from that presented to the other. The tests differ
from each other by the stimuli used and the task required of the listener. Stimuli can
be digits, nonsense syllables, words, and sentences.

Listeners are asked to listen to the stimuli presented through the headphones or
inserts. They are told which message they should repeat. For binaural separation
tasks, the listener will be asked to focus on the message in a particular ear and repeat
only what is heard in that ear only. For binaural integration, the listener will be asked
to repeat the messages they hear in both ears.

Examples of Dichotic Listening Tests: Dichotic Digits, Staggered Spondaic Words

Temporal Processing Tests

Temporal processing is important in everyday listening tasks such as speech
perception. It helps in the discrimination of subtle cues such as voicing and
discrimination of similar words.

Examples of Temporal Processing Tests: Random Gap Detection Test, Frequency
(Pitch) or Duration Patterns

Monaural Low-Redundancy Tests

The redundancy of the auditory system pathways and in spoken language allows
normal listeners to achieve closure and make auditory identification possible even if
part of the signal is missing. Listeners with (C)APD can perform quite well when
auditory stimuli are presented in an ideal situation using phonetically balanced words
and a quiet listening environment. When the task is made more difficult by distorting
the signal the listener with (C)APD will demonstrate significant problems.

Low-Pass Filtered Speech Tests: Willeford central test battery (Willeford, 1977),
SCAN-C Filtered Words and Auditory Figure-Ground Subtests

Binaural Interaction

“Binaural Interaction” refers to the way in which the two ears work together.
Functions that rely on binaural interaction are localization and lateralization.
Binaural release from masking, detection of signals in noise, and binaural fusion are
also functions that rely on binaural interaction.

Test for Binaural Interaction
Speech Masking Level Difference Test

Auditory Discrimination

Auditory discrimination is the ability to differentiate behaviorally between auditory
stimuli of many types. Children with auditory discrimination deficits may perform
poorly on speech and language measures involving phonological awareness and
similar tasks.

Auditory Discrimination Tests: Northwestern University PEST paradigm
*Equipment not typically available at most clinics

Auditory Evoked Potentials measures

These measures are not included in our clinic‟s standard (C)AP protocol but may be
recommended based on the results from the test battery.

Auditory Brainstem Response (ABR)
Middle Latency Response (MLR)
Late Event-Related Potentials (LEP)
Probe Tube/Real Ear Measures

Under Construction
Aided Soundfield Testing

Place client in front of the loudspeaker, usually at a zero degree azimuth.

Functional Gain

Using warble tones determine unaided thresholds for the frequencies of 500, 1000,
2000, 3000 and 4000 Hz.

Place hearing aids on client and obtain aided thresholds at the same frequencies.

The difference between the thresholds at each frequency is the functional gain at that
frequency.

Older hearing aid prescriptions called for functional gain.

Aided hearing thresholds

Using warble tones determine aided thresholds for the frequencies of 500, 1000,
2000, 3000, and 4000 Hz.

The DSL-i/o prescription offers aided soundfield threshold targets.

Aided word recognition testing

Unaided and aided word recognition testing can also be completed.
Electroacoustic Measurements

Under Construction


Hearing Aid Visual Listening Check

Question client about the problem(s) s/he is experiencing with the hearing aid(s) at
this time.

Review any of the following subjective and/or management concerns that appear
appropriate:
      Physical fit/comfort
      Sound quality/clarity
      Feedback/ Internal noise
      Listening situations that they are having problems with (background noise, TV,
      telephone etc.)
      How are they handling the hearing aids (insertion, removal, adjustments etc.)

Complete a visual check of the hearing aid(s)

Complete a listening check of the hearing aid (s)
  After insuring that you have a good battery in the hearing aid, attach the flange of
  the hearing aid stethoscope on the end of the earmold or hearing aid case. Place
  the stethoscope ear tip in your ear. Clean ear tip after each use.

After determining the problem with the hearing aid(s) if the problem can be fixed in
office make sure to discuss with supervisor what needs to be completed. With
supervisor‟s permission, continue with adjustments or repairs on the hearing aid(s). If
the hearing aid(s) need to be sent to company for repair, discuss this with the client
and give estimated cost for repair and estimated time it will take for the hearing aid(s)
to be returned to ECU Speech and Hearing Clinic.
Transient and Distortion Product Otoacoustic Emissions

Transient Otoacoustic Emissions

Under Construction

Distortion Product Otoacoustic Emissions

Under Construction
Auditory Evoked Potentials

     Child and Adult Evoked Potentials: threshold estimation with tone bursts

     Electrode array that is used is the ipsilateral array. After electrodes are in place
     an impedance check is completed.

     When testing an adult choose the adult setup and if testing a child choose the
     child setup (check names in directory)

     Begin testing at 2000 Hz at 30 dB nHL look for wave V if wave appears go to
     500 Hz, 1000 Hz and 4000 Hz.

     If wave V is not present raise intensity to 50 dB nHL, look for wave V. If wave
     V appears decrease intensity until wave V is not visible or 30 dB nHL is
     reached.

     After running 50 dB nHL stimulus set, if wave V is not present raise intensity
     to 80 dB nHL, look for wave V. If still not present raise level to 90 dB nHL. If
     waveform continues to be absent change frequencies and continue testing as
     stated above. When wave V appears then lower the dB level until wave V is
     not present. The lowest intensity level at which the wave V appears above the
     absence of wave V is threshold. Then repeat for 500 Hz and follow the same
     directions. Go on to 1000 then 4000 Hz and determine threshold for each of
     these frequencies.

     If time allows and hearing loss is suspected continue with bone conduction
     testing.

     Adult Evoked Potentials: Neurologic testing

     Electrode array that is used is the multiple electrode array (correct name ???).
     After electrodes are in placed, an impedance check is completed.
     Choose adult setup- clicks.
     Run levels at 80 dB nHL. Watch for waveform latencies and amplitudes.
     Compare with norms and compare wave forms between ears.
Vestibular Evaluation

Equipment
     Micro Medical Technologies
     ENG/VNG/Rotary Chair
     If client has not had a hearing evaluation, a comprehensive hearing
     evaluation must be completed before testing.

Set-up procedures

        Rotary Chair Protocol- Use the Free View Infrared Cameras or
        electrodes, lights are turned off.
        Horizontal & Vertical Calibration must be completed before testing
        can start.
Tests
        Spontaneous Nystagmus- instructions to the client are to stare at the dot
        and when the dot disappears remain staring in that same spot; have client
        start staring at the dot (record 20 seconds) then dot goes away (record
        20 seconds) If nystagmus is present record longer than 20 seconds.

        Gaze Nystagmus (horizontal)- Instruct client to Gaze to the right
        (record 20 seconds), eyes move back to midline, then Gaze left (record
        20 seconds). If nystagmus is present in any position record longer than
        20 seconds.

        Gaze Nystagmus (vertical)- Instruct client to Gaze up (record 20
        seconds), eyes move back to midline, then Gaze down (record 20
        seconds). If nystagmus is present in any position record longer than 20
        seconds.

        Saccades (horizontal)- Instruct the client to follow the bouncing dot by
        moving their eyes only. (Records for 60 seconds)

        Saccades (vertical)- Same directions as horizontal saccades. (record for
        60 seconds)

        Pursuit - Instruct the client to follow the moving dot, moving eyes only.
        Run at three speeds/frequencies (Record for 30-40 seconds, or you may
        stop if you record 5 good cycles)
           Optokinetics (OPKs)- Record with lights moving right and left 15
           degrees/second and 30 degrees/second. (Record 10-15 seconds per
           direction)

Finished with Rotary Chair move to ENG protocol

     Calibrate- Horizontal and Vertical Channels
     Positioning tests - Goggles are used and closed for these tests.
           Dix-Hall Pike- Have client in sitting position, rapidly move them to a
           supine position with the right ear down. (record for 30 seconds) If you
           see nystagmus continue to record looking for direction changing, or
           persistent nystagmus. Return client to sitting posting and repeat if
           necessary. Repeat procedure with left ear down.

     Positional Testing- Record client‟s eye movements in a minimum of four
     static positions
            Supine
            Supine with Head right
            Supine with Head left
            Supine with Head Hanging
                   If nystagmus is present in a position, record in the lateral position.
                   (Lying on right side and/or lying on left side)

     Calorics- Water or Air- Goggles are closed for these tests. Perform otoscopy if
     not completed previously. Position client at a 30 degree incline. Purge system
     before each caloric. Irrigate ear for 30 seconds. Start recording with foot pedal
     at the beginning of the irrigation. Recording time is up 2 minutes. Client must
     be tasked (ex. boys or girls name, city, fruits.) At 1½ minutes fixation must be
     tested. Tester must push button and hold on the goggles, light will turn on,
     instruct client to stare at light for 10-15 seconds. Light goes out and continues
     recording for 30 more seconds. Wait at least 5 minutes between recordings.
            Start with Right warm
            Left warm
            Left Cool
            Right Cool

           Keep client lying down for at least 5-10 minutes after all testing.
           Remove goggles. Sit them up and make sure client is feeling no
           dizziness before letting them leave.
      If there is a bilateral weakness with calorics, further rotary chair tests need to
      be completed.

      Rotary Chair
      Seat client in chair with free field goggles on.
      Turn lights out and complete ocular motor series.

            Sinusoidal acceleration- complete testing as listed on the setup of the
            Micromedical system. A minimum of five cycles will be completed for
            each test. Task client during tests.

            Velocity step test- Instruct the client that the chair will be moving
            clockwise and counterclockwise for 2 minutes then the chair will stop.
            They need to keep their eyes open and looking forward. Client is
            wearing goggles, can be tasked or non-tasked. The system records for 90
            seconds to 2 minutes while in motion and for 90 seconds to 2 minutes
            after the chair stops.

When testing children complete Rotary chair protocols and calorics using the same
procedures.
Hearing Aid Fitting & Orientation

Have client complete Hearing Aid Expectations and Pre-Benefit Measures if not
completed at Hearing Aid Evaluation appointment.

Run probe tube measures for soft sounds using a 50 dB input signal. Measure
maximum real ear output levels using an 85-90 dB SPL input. Adjust the hearing
aid(s) output to prevent loudness discomfort.

Orientation Procedures:
     Verify and file Medical Clearance/Waiver;
     Signatures need to be obtained on Hearing Aid Purchase Agreement form;
     Review payment policy;
     Review client brochure(s) related to function, use, safety issues, and care of
     hearing aids;
     Review 3-year loss, damage, and repair warranty;
     Demonstrate and have client practice battery placement, insertion and removal
     of hearing aids, on/off, changing programs;
     Demonstrate and have client practice hearing aid care practices;
     Suggest use schedule;
     Discuss realistic expectations;
     Discuss and practice telephone use;

Ask client if there are any questions before leaving and schedule for the client to
return for a one or two week follow-up appointment.
                                  East Carolina University
                          SPEECH-LANGUAGE & HEARING CLINIC
                                 LAHN Bldg., Room 1310
                                       SAHS; ECU
                                   Greenville, NC 27858
                                       252-744-6104

                     HEARING & HEARING AID EVALUATION REPORT
                                     08-08-2006

Name:                                 Mrs. J
Parent(s)/Guardian(s):                NA
Address:

Phone:
D.O.B.:                               09-04-38
Age:                                  68
Sex:                                  Female
Referral Source:                      Dr. S. Rezare

Dr. S. Rezare referred Mrs. J. to this clinic reportedly to determine the nature and degree of her
apparent hearing loss and whether she might obtain hearing aids. Mrs. J‟s daughter, Miss. Ruth
Ann Jones, accompanied her to the clinic. In the following report, the summary and
recommendations are offered first with the history, results, and audiogram attached.

SUMMARY & RECOMMENDATIONS

Mrs. J has a moderate-to-severe sensorineural hearing loss. She would be expected to experience
significant listening difficulties unless those communicating with her use loud speech within 6-8
feet in a quiet environment. She is an excellent hearing aid candidate and the HEAR NOW
(National Hearing Aid Bank) program was reviewed as a means for obtaining two digital half-shell
in-the-ear hearing aids. Mrs. J was offered the application packet and the necessary audiological
data so that she can complete the application and mail it to HEAR NOW. It is expected that she
will be approved and at that time she will be scheduled to return for ear impressions so that custom
built digital hearing aids can be ordered.

The following recommendations were discussed and agreed upon:

1. Mrs. J should complete and submit the HEAR NOW application requesting approval for two
new digital half shell in-the-ear hearing aids.

2. Once approved, Mrs. J should be scheduled to return to the clinic for ear impressions and the
subsequent fitting of new hearing aids.

3. Mrs. J should have her hearing re-evaluated annually.
HISTORY

Over the past four to five years Mrs. J has noticed hearing difficulties across a wide range of
listening situations including communication at home, in church, in the grocery store, in doctor‟s
offices, and when conversing on the telephone. “Many years ago” she had her hearing tested in
Goldsboro and those results reportedly indicated hearing loss in both ears with poorer hearing in the
left ear. Mrs. J indicated that she was uncertain as to whether she had ear infections as a child. She
does have occasional ringing in both ears and notices it more in the left ear. Mrs. J is taking the
following medications: Cozaar, Zocor (cholesterol), Insulin for diabetes, Prevacid for reflux, and
Advair for asthma.

RESULTS & IMPRESSIONS

Otoscopy revealed normal appearance of the ear canals and ear drums and minimal earwax in both
ears.

Pure tone air and bone conduction threshold testing revealed a moderate-to-severe sensorineural
hearing loss in both ears. Speech recognition thresholds were in good agreement with pure tone
averages, supporting the degree of pure tone hearing loss.

Word recognition ability was evaluated in quiet using recorded word lists at an elevated yet
comfortable presentation level, yielding scores that were within the expected range for this degree
of hearing loss.                                   .

Please do not hesitate to contact us should you have any questions or concerns.

 _______________________________
 Deborah Culbertson, Ph.D. CCC-A
 Clinical Supervisor


c:     Mrs. J

       Dr. S. Rezare
       ECU Physicians
       600 Moye Boulevard
       Greenville, North Carolina 27834
                                     East Carolina University
                             SPEECH-LANGUAGE & HEARING CLINIC
                                    LAHN Bldg., Room 1310
                                          SAHS; ECU
                                      Greenville, NC 27858
                                          252-744-6104

                                 (Central) Auditory Processing Evaluation
                                                 May 19, 2005

Name:                                             Parent(s):
Birthdate:                                        Age:
Address:
Phone:
Referral Source:                 Dr. R.

Dr. R referred TP for a (central) auditory test battery. TP‟s mother, Mrs. Gloria ___ accompanied TP to this
evaluation session. This report offers the summary and recommendations first with the test battery
description and results following.

SUMMARY

The following auditory processes were evaluated: auditory closure, binaural integration, binaural
separation, auditory temporal patterning, auditory temporal resolution, and binaural interaction.
Testing revealed that TP has an auditory processing deficit in the area of binaural interaction. This reflects an
inability of the auditory system (at the brainstem level) to use timing and intensity information that is
different at the two ears. The ability of the auditory system to use different timing and intensity information
from the two ears allows us to locate and focus our attention on people speaking from different places
throughout a room, and helps us to better sort out and identify the speaker‟s message from the background
noise in the room. It is common for children with a significant history of ear infections to show deficits in
this area.

RECOMMENDATIONS

A primary recommendation for a deficit in binaural interaction is the use of an FM system in the classroom.
Because TP is reaching the age where she will be changing classrooms a loudspeaker based system would
not be advised. TP is reportedly moody and self-conscious and that would make use of a desktop or headset
system difficult. A Phonak Edu-Link system is lightweight and of limited visibility and would be the ideal
system for use.

The following recommendations are made in order to minimize the impact of binaural interaction in the
classroom:
    1. Use of a Phonak Edu-Link FM system to assist TP‟s hearing of her classroom teachers;
    2. Reduction of background noise and placement of TP away from noise sources, whenever possible;
    3. Positive reinforcement of TP when she seeks clarification of spoken information and/or directions;
    4. Comprehension checks to make sure that spoken information and/or directions are understood.
    5. Preview of classroom vocabulary, if possible, so that new terms and concepts are not heard for the
        first time in the classroom.
HISTORY

Mrs. ___ stated that TP has attention deficit hyperactivity disorder (ADHD), and that she had taken a daily
dosage of Ritalin on this test date. TP had recurrent ear infections during the first year of life and had
pressure equalization tubes placed in both ears at the age of one year. The ear infections reportedly resolved
after that surgery.

Mrs. ___ stated that TP often focuses more on what she sees than on what she hears. For example, TP
focuses her attention on the television and misses comments and directions that are presented to her during
television shows. If TP is given a short set of directions, she often misses part or all of the directions,
suggesting short-term memory problems. Mrs. ___ also stated that TP appears to have forgotten concepts and
terms that were learned earlier in the school year, suggesting possible long-term memory problems. In order
for TP to complete her homework, Mrs. ___ reportedly must prompt and direct TP and assist in writing out
homework responses.

When asked about the benefits of ADHD medication, TP stated that the medications made her feel “weird” at
times and that she still continued to daydream and lose focus in the classroom. Mrs. ___ stated that TP has
taken various medications and that some have appeared to be extremely helpful for short-term periods (e.g., a
few months). According to Mrs. ___, TP also experiences many mood swings and this impacts everyday life
at home and in school.

TP underwent a Scottish Rite Foundation Language & Dyslexia Evaluation at this clinic in March of this
year. Based on that evaluation, recommendations were made for school-based activities to assist in
phonological decoding and spelling, to pursue a central auditory processing evaluation to rule out auditory
processing as an underlying cause of difficulties, and to pursue further evaluation of reading and writing.

(CENTRAL) AUDITORY PROCESSING TEST BATTERY

The purpose of the (Central) Auditory Processing evaluation is to assess an individual‟s ability to interpret
information that s/he hears. The term “central auditory processing” refers to our abilities to attend to,
discriminate, recognize, remember, and/or comprehend information presented auditorally. Any disruption in
one or more of these abilities results in a person having difficulty remembering a set of spoken directions,
paying attention in noisy environments, and understanding and producing language. These types of
difficulties can limit learning and day-to-day functioning. Because the central auditory nervous system is
responsible for these tasks, the inability to perform these tasks is considered indicative of a “central auditory
processing disorder” (CAPD). A central auditory processing disorder can encompass one or more auditory
process.

The central auditory test battery can include evaluations of the following processes:
   1. Auditory Closure---the ability to identify missing or distorted portions of words and/or messages
       (Willeford Filtered Speech Test or SCAN-C Subtests on Filtered Words & Auditory-Figure
       Ground).
   2. Binaural Integration---the ability to process and identify different messages at both ears (Staggered
       Spondaic Word Test or SCAN-C Competing Words Subtest).
   3. Binaural Separation---the ability to process an auditory message coming into one ear, while ignoring
       a different message being presented to the opposite ear (Willeford Binaural Separation Competing
       Sentences Test or SCAN-C Competing Sentences Subtest).
   4. Auditory Temporal Patterning---the ability to recognize acoustic patterns/contours which
       contribute to the listener‟s ability to extract and use prosodic aspects of speech, such as rhythm,
       stress, and intonation (Pitch Pattern Test or Duration Pattern Test).
    5. Auditory Temporal Resolution---the ability to detect rapid changes in stimuli (Random Gap
       Detection Test);
    6. Auditory binaural interaction---the ability to use different frequency or timing information when
       the same word or tone is presented to each ear, but with different frequency components or timing
       (Speech or Tonal Masking Level Difference Test or Willeford Binaural Fusion Test).

                                          EVALUATION RESULTS

Test Behavior: TP was cooperative throughout testing. She stated her intent to do well on the testing and
was interested in how well she was performing.

Medication Use: TP had taken Ritalin on the day of testing.

Ear & Hearing Status: TP passed a 15 dB HL hearing screening at octave test frequencies ranging
from 500-4000 Hz and normal tympanograms were recorded from both ears. These results
suggested normal hearing and middle ear status on this test date.

Auditory Processing Evaluation Test Battery: Results that were more than 2 standard deviations below
the mean were considered abnormally poor (bolded) and considered indicative of auditory processing deficit.
                                                     Raw Score        Interpretation
    1. Auditory Closure

        SCAN C Filtered Words                           37               within 2 SD of mean
        SCAN C Auditory-Figure Ground                   31               within 2 SD of mean


    2. Binaural Integration

       SCAN C Competing Words                           48               within 2 SD of mean
    3. Binaural Separation

        SCAN C Competing Sentences                      11               within 2 SD of mean

    4. Auditory Temporal Patterning

        Pitch Pattern Sequence Test
        Soundfield with Verbal Labeling                 30/30            within 2 SD of mean

    5. Auditory Temporal Resolution

        Random Gap Detection Test                       13.75 ms         within 2 SD of mean

    6. Binaural Interaction

        Speech Masking Level Difference                 3 dB             > 2 SD below mean
Please do not hesitate to contact me should you have any questions or concerns.


______________________________
Deborah S. Culbertson, Ph.D. CCC-A
Audiology Clinic Director


Cc:           Mrs. Gloria ___

              Dr. R

              Ms.
              Counselor
              West Greene Elementary School
              FAX report to: 747-7591

              Dr. S F
              EPBS
              925 Conference Drive
              Greenville, NC 27858
                                   East Carolina University
                           SPEECH-LANGUAGE & HEARING CLINIC
                                  LAHN Bldg., Room 1310
                                        SAHS; ECU
                                    Greenville, NC 27858
                                        252-744-6104

                               Hearing Aid Fitting and Orientation
                                           10-20-0X

Name:
Address:

Phone:
DOB:                  12-26-98
Age:                  5 years

J, a five-year-old boy with mild sensorineural hearing loss, was seen for a hearing aid fitting and
orientation. He will be using these hearing aids when not in school with the exception of times
when he is sleeping or napping, involved in water-related activities, or in high-impact sports.
During the school day, he will be using an FM system provided by the school system. His mother
and younger sister accompanied him to the clinic for this session.

The summary below presents the pre-fitting, fitting, and orientation activities conducted.

Pre-fitting Procedures:
        2 Perseo 111 dAz mini behind-the-ear hearing aids, 2 soft shell earmolds, 3 packs of #13
        batteries, user brochures, and a Pediatric Care Kit were available at the time of the fitting.
        Visual/Listening and Electroacoustic check procedures were completed on both hearing aids
        to insure function according to manufacturer specifications.
        Preliminary programming of hearing aids included use of the DSL-i/O prescription, de-
        activation of the tactronic/touch switch function and programmed automatic switching
        between Quiet (omnidirectional) and Noise (directional) programs;

Hearing Aid Fitting and Adjustment:

Both earmolds fit comfortably in J‟s ears.

Probe tube measures were used to adjust hearing aid gain for a soft 50 dB input level to
approximate the DSL- i/O prescription for each ear and audibility was achieved from 250 through
6000 Hz. An 85 dB SPL signal was used to determine maximum real ear output levels and the
highest output levels for both ears were below 105 dB SPL. J accepted the fitting of the hearing aids
and did not report discomfort with the fit or any of the sound levels used during testing.

Orientation Procedures:
       Verification and filing of Medical Clearance from Dr. Wilbert Cain;
       Signatures obtained on Hearing Aid Purchase Agreement form;
       Reviewed payment policy and obtained signatures on HCFA forms;
       Reviewed client brochure(s) related to function, use, safety issues, and care of hearing aids;
       Reviewed 3-year loss, damage, and repair warranty;
       Demonstration and practice of battery placement, insertion and removal of hearing aids,
       on/off functions;
       Demonstration of hearing aid care practices & attached hearing aid check reviewed;
       Suggested use schedule discussed & attached handout provided;
       Realistic expectations discussed;

J showed interest in the hearing aid components and controls, and in learning how to place the
earmolds and hearing aids in his ears. He was extremely cooperative and positive throughout the
fitting and orientation session. J‟s mother was advised to place and switch on the hearing aids
during the initial weeks but to follow J‟s lead with respect to involving him in hearing aid use and
care routines.

Client follow-up session goals:

The audiologist will contact Mrs. F in a few days and schedule a trial period check up visit, and the
following goals are established for that visit:
    1. Obtain feedback on real-world use of hearing aids;
    2. Make adjustments to amplification and/or earmolds, as needed;
    3. Review use of the drying kit;

______________________________
Deborah Culbertson, Ph.D. CCC-A
Audiology Clinic Supervisor

cc:    Mr. and Mrs. F                                Dr. Wilbert Cain
                                                     1050 Jabarra Ave.
       Ms. M                                         Seymour Johnson AFB, NC 27531
       Rosewood Elementary School
       126 Charlie Braswell Road
       Goldsboro, NC 27530
                        Hepatitis B Vaccine Information/Declination Form



Hepatitis B Information:

       I have had or am currently in the process of having the Hepatitis B vaccine administered to
me and will provide the Department of Communication Sciences and Disorders with a copy of my
vaccination record.

Signature:________________________________                     Date:_________________________




Hepatitis B Declination:

        I understand that due to my occupational exposure to blood and other potentially infectious
body substances that I may be at risk of acquiring hepatitis B virus (HBV) infection. For personal
reasons, I choose not to have the hepatitis B vaccination. I understand that by declining, I remain at
risk of acquiring hepatitis B, a serious disease. If I decide to obtain this vaccination in the future, I
will notify the Director of Clinical Operations and provide a copy of the vaccination record to the
CSDI department.


Signature:_____________________________                        Date:_______________________


Witness:______________________________
                                 HIPAA Requirements in Audiology Clinic

As you know HIPPA regulations must now be followed and the requirements are below:

Notice of Privacy form: to be used for all clients seen April 15th, 2003 and on at their first visit and each
year thereafter.

 A multi-page "Notice of Privacy" should be in your client’s file. You are asked to fill in the top sheet with
appropriate signatures and then they are given the remaining informational pages to review at a later
time.

Release of Information forms: one or both will be needed for most clients seen

There are now two separate releases:
1. individual's request for information---releasing to themselves;
2. disclosure request---releasing to others;

On these forms, we need to indicate "Other" and state the type of report to be sent (hearing evaluation,
CAP eval., etc.) and the dates of information requested which would be your test date(s).

Those releases are only good for that one request. If clients decide at a later date that they want
additional reports mailed, they would need to fill out another request for information form.

Restriction form: will be used on an infrequent basis;

Form to restrict report from going to a family member---to be used on rare occasions

Request for Accounting of Disclosures form: will be used on an infrequent basis by the front office.

Client requests information on recipients of his/her reports.
This form must be completed by the client and then sent to ECU Privacy Officer, and they respond to the
request

Request for Amendment form: CAREFUL; this should be used on an infrequent basis

If any changes are made to a finalized report, then the client would need to submit this request to change
the report

If there are errors in reports that need to be changed, the form would still need to be made

Complaint form: will be used on an infrequent basis, available in the front office;

Relates to complaints related to confidentiality and HIPPA procedures

Log form: used in all client files; used by front office;

Used by front office to log the mailing of reports
Used by supervisor if you provide a copy of results/audiogram to go out with client prior to the final report

Confidentiality and Reporting: applies to all clients;

Clinical data sheets (audiograms and tests) are not to go home

Clinic reports are no longer to be typed at home and/or saved on floppy disks, CDs, etc.
Reports are to be typed and saved on a computer hard drive within the clinic or faculty member's office
and saved to the piratedrive.

Report versions should probably be printed out to avoid loss related to computer problems, and hard
copy versions should be safeguarded very carefully. Drafts of audiology reports should be placed in
client folders in reports pending files (top left file cabinet in clinic).

When discussing clinical cases outside of the clinic itself, there should be no mention of identifying
information, unless the student & supervisor are behind closed doors.
                                  East Carolina University
                                  Infection Control Policy

East Carolina Speech-Language and Hearing Clinic
Policy Number:


Page 1 of 4                                           Effective Date:
                                                      Last Revision Date:


Approved by:


______________________________                       ______________________________
Director, Infection Control                           Administrator/Manager, Department


PURPOSE

To protect patients, staff, and students from infection

PHYSICAL ENVIRONMENT

Hand washing facilities: These are located in the clinic restrooms. In addition, waterless hand
sanitizing agents will be available in all clinical areas.

Separation of clean and soiled activities: The Clinic only stores items associated with clean
activities. Soiled items are either disposable and discarded after use, or cleaned following use with
an approved disinfectant.

Traffic Control: No unauthorized individuals will be allowed in the clinic evaluation and/or
treatment rooms.

Cleaning Schedule: Clinical areas and restrooms will be cleaned daily by ECU Facilities Services.

Cleaning between patients: Any disposable items used by patients that are not contaminated (e.g.,
otoscope specula, earphone tips) will be discarded immediately after use into plastic-lined trash
cans which are emptied daily. The majority of patient use items are disposable. Non-disposable
items (some impedance ear tips) and clinical surfaces that are contacted by patients will be
disinfected and/or sterilized according to guidelines.
EQUIPMENT AND SUPPLIES

All infection control supplies will be obtained from the stockroom and stored in a cabinet in the
Clinical Suite.

Personal protective equipment is located in a cabinet in the Clinical Suite and in the Audiology
Clinic.

The Clinic Suite will have appropriately labeled contaminated trashcans (red bag) and non-
contaminated trashcans (clear or brown bag).

Clinical tools and/or supplies will be considered “contaminated” when they have been directly
exposed to “infectious waste”, including blood, pus, saliva, and/or other body fluids. Any
contaminated non-sharp disposable tools or supplies will go in the red bag trash, and any non-
contaminated disposables will go in the clear or brown bag trash.

All oral-motor exams will be done with gloved hands. Disposable latex and non-latex gloves will
be available for use. After use, non-contaminated gloves will be discarded immediately into plastic-
lined non-contaminated trashcans that are emptied daily.

After use, tissues and tongue blades that are not contaminated shall be discarded into plastic-lined
non-contaminated trashcans that are emptied daily.

Disposable audiometric ear tips and electrodes (e.g., impedance, otoacoustic emissions, insert
earphone tips, specula) that are not contaminated will be discarded after patient use into non-
contaminated plastic-lined trashcans that are emptied daily.

Brainstem Auditory Evoked Response electrodes (flat surface electrodes) that are non-disposable
will be cleaned in soap and water immediately after each use and disinfected with alcohol.

The audiometer headphones and bone conduction vibrator will be cleaned with alcohol between
patient uses. Disposable headphone covers may also be used to prevent transmission contact with
headphone use.

Assistive listening device equipment will be cleaned and disinfected in an approved disinfectant
between patient uses.

Clinicians will wear gloves during clinical activities when there are open cuts/sores on the skin of
the patient or clinician, when either one has an infectious disease or when there is the possibility of
contact with bodily fluids. Gloves also are worn when cleaning, disinfecting, or sterilizing
equipment.

Patient hearing aids and ear molds will be received in a gloved hand, paper envelope, or container
and wiped with a disinfectant wipe prior to examination.
Augmentative aid covers on Vocaid and VOIS equipment will be removed and thoroughly washed
and disinfected with approved disinfectant before being reassigned to another patient.

After use, reusable ear tips that are not contaminated are cleaned and placed in a disinfectant
solution bath located in the Audiology Clinic Test Suite.

Reusable tools and tips that are contaminated will be placed in a disinfectant sealed tub on the upper
shelf in the VTR room. The Audiology Clinic Director will be notified that these items need to be
sterilized, and then she will place them in the closed cover sterilization bath on the upper shelf in
the VTR room.

Sterilization of contaminated non-sharp, non-disposables will take place in a covered-lid bath of
Glutaraldehyde Solution. The sterilization bath will be located on an upper shelf in the VTR room
within the Clinical Suite.

Equipment will be inspected regularly and repaired or replaced as necessary.

A Sharps disposal unit is located in the Neuroscience lab unit in the Clinic Suite.

PERSONNEL

Immunizations
  All employees will comply with pre-employment and annual health screening. Refer to
  the Occupational Health Services policy for Occupational Health requirements for all
  department personnel.

Clothing
 All staff and students will follow the Department Dress Code Policy.

 Disposable gowns are to be used during procedures where body fluids may splash.

 Eye shields are to be worn during procedures where body fluid or debris may make
 contact with the eyes.

Precautions in patient areas to avoid spread of disease.
  All personnel will wash their hands with appropriate cleansers before and after every
  patient.

Appropriate In-service
 During clinic orientation, students and staff will receive training on the principles and
 methods of infection control within the department and areas
 served by the department.

 On-going in-service education should be attended by all students and staff concerning
 infection control techniques or procedures useful to the members of this particular
 department.
 Each student and staff member must attend an annual inservice on infection control.

PATIENTS

All patients being transported to East Carolina who are susceptible to infection (i.e., burns, open
wounds) shall have opened areas covered and secretions contained. Patients on AFB, or Airborne
Precautions, will be required to wear a mask when being seen in this clinic.

No service will be refused because barriers are in effect.

MONITORING PLAN FOR STAFF COMPLIANCE TO UNIVERSAL STANDARD
PRECAUTIONS

Random monitoring will be ongoing and reviewed annually by the Director of Clinical Operations
and Audiology Clinic Director.

Faculty, staff, and students will be informed of the results of the monitoring at the end of each
academic year by the aforementioned directors.

REVIEW OF POLICY

The Infection Control Policy for the Department of Communication Sciences and Disorders will be
reviewed every 3 years or as needed.
                             Procedure for Sterilization of Devices
                          with the Sterilizing Agent approved by ECU

Non-disposable clinical items/devices that are “contaminated” necessitate sterilization.
Because sterilization procedures are fairly lengthy and exacting, however, it may be more
efficient and cost effective to throw away these items if they are fairly low in cost (e.g.,
immittance tips).

At ECU Speech-Language & Hearing Clinic, we have relatively few non-disposable clinical
items/devices that are “contaminated”. It is suggested that low-cost “contaminated” items be
disposed in red bag trash.

If an item is “contaminated” and it is not a low cost item that could be disposed in red bag
trash, then handle it in gloved hands, and clean by rinsing or wiping off as much debris as
possible. Then place it in a sealed plastic tub above the sink in room 1310J and advise the
Audiology Clinic Director and/or Dr. Sharon Rutledge as soon as possible.

Sterilization Procedure---Used by Audiology Clinic Director or Director of Clinical Operations

CIDEX Solution should not be diluted.

   1. Activation:
         a. Activate the CIDEX Solution by adding the entire contents of the Activator Vial,
             which is attached to the CIDEX Solution container.
         b. Shake well.
         c. Activating solution immediately changes color to green only indicating that the
             activator has been added to the solution.
         d. Record the date of activation, and record the expiration date.
         e. Test the activated solution with CIDEX Solution test strips.

   2. Usage
         a. Test the solution with test strips to assure concentration levels.
         b. Immerse cleaned and rough dried medical devices completely in the CIDEX
            Solution, filling all lumens.
         c. Leave devices completely immersed for the required time at the appropriate
            temperature, 25o C immersion time of at least 45 minutes.
         d. At the end of the required time remove devices from the solution using aseptic
            technique.
         e. Rinse thoroughly with the appropriate quantity of water following the rinsing
            instructions below.
         f. Re-use CIDEX Solution in accordance with the conditions stated below.


   3. Rinsing Instructions
         a. Following removal from solution, thoroughly rinse the medical device by immersing
            it completely in three separate copious volumes of water.
       b. Each rinse should be a minimum of 1 minute in duration unless otherwise noted by
          the device manufacturer.
       c. Use fresh portions of water for each rinse.
       d. Discard the water after each use.
       e. Do not reuse the water for rinsing.


4. Monitoring of Disinfectant to Ensure Specifications are Met
     a. During the use of CIDEX Solution it is recommended that a thermometer and timer
         be used to ensure that the optimum usage conditions are met.

5. Storage Conditions and Expiration Date
      a. Prior to activation, CIDEX Solution should be stored in its original sealed container
         at controlled room temperature 15o- 30o C.
      b. Once the CIDEX Solution has been activated, it should be stored in the original
         container until transferred to the closed containers in which the immersion is to take
         place.
      c. Container should be stored in a well-ventilated, low traffic area at controlled room
         temperature.
      d. The expiration dates of the inactivated CIDEX Solution and activator will be found
         on the container.
      e. The use period for activated CIDEX Solution is for up to a maximum of 14 days
         following activation or, as indicated by the CIDEX Solution test strips.

6. Disposal Information
      a. CIDEX Solution Disposal- Discard residual solution in drain or per hospital policy.
         Flush thoroughly with water.
      b. Container Disposal- Do not reuse empty container. Rinse with water, and dispose
         per hospital policy.
              East Carolina University---Audiology Clinic Rotation
                            Clinical Feedback Form
Student:_______________________________      Supervisor:__________________________
Date:_________________________________       Site:________________________________
Strengths observed by supervisor:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
      Student comment:




Areas needing improvement observed by supervisor:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________


      Student comment:



Plans for Improvement:
       Student Responsibilities:
             1._______________________________________________________________
             2._______________________________________________________________
             3._______________________________________________________________
      Supervisor Responsibilities:
            1.______________________________________________________________
             2.______________________________________________________________
             3.______________________________________________________________
                       Audiology Clinical Clock Hour Log Sheet---CSDI---East Carolina University
Student                                                              Semester & Year


Setting

Date        Client        Activity      Hours        Supervised              Clinical Supervisor’s Signature
            Initials      Code                       Hours            (Please sign legibly and include ASHA # if off
                                                                                         campus.)




                                           Age Designators
                         IT (infant toddler) birth to 2.11 yrs.
                         P (preschool) 3 to 4.11 yrs.             A (adult) 18 to 64.11 yrs.
                         S (school-age) 5 to 17.11 yrs.           G (geriatric) 65 yrs. and up

Adult Aud. Eval. & Screen     Amp./Sensory aids/ALDS       Adv. Dx-EPs & Vest.
Eval Adult          A1        Amp Adult       B1             EP Adult     A3
ID/Screen Adult     C1        Amp Child       B2             EP Child     A4
                                                             Vest. Adult  A5
                                                             Vest. Child  A6
Child Aud. Eval. & Screen    Aural Rehab.       SLP ID-Speech-Lang. Screen                 Other Related
Eval Child        A2         AR Adult B3        Screen Adult        C3                     Staffing D1
ID/Screen Child C2           AR Adult B4        Screen Child        C4                     Record/Doc.      D2
Admin.          D3
East Carolina University: Evaluation of Clinical Audiology Competency
Individual completing this form:________________________________________________________
Name of clinical site:________________________________________________________________
Clinician being evaluated:____________________________________________________________
Date form was completed:____________________________________________________________
Total Months at this clinical placement:__________________________________________________

We would greatly appreciate it if you would:
  1) rate the professional behaviors below (page 1);
  2) rate the competencies as instructed (pages 3 & 4);
  3) offer an overall grade recommendation with overall comments (page 2);
  4) FAX the entire evaluation to Deb Culbertson at 252-744-6148.


Professional Behaviors: Please use a numeric ratings or NA (not applicable) for each statemen
   1   Exemplary
   2   Satisfactory
   3   Unsatisfactory

The clinician:
___1. is present, punctual, and prepared for the clinical assignment;
___2. is properly attired;
___3. demonstrates respectful behavior and language;
___4. is thorough and timely in completion of clinical documentation and follow-up;
___5. takes responsibility for work and assignments (i.e., does not excuse self or blame others);
___6. actively seeks ways to expand knowledge;
___7. shows appreciation for clinical views that differ from his/her own or those taught at the universi
___8. discusses clinical goals with supervisor & re-negotiates goals as needed;
___9. works at improved performance;
___10. requests meeting with supervisor to discuss issues and/or concerns, as needed;
___11. follows clinic procedures;
___12. demonstrates self-evaluation of clinical skills and abilities

Other comments on professional behaviors:




**If the clinician is showing unsatisfactory performance on any of the above behaviors,
please contact Deb Culbertson, culbertsond@ecu.edu OR 252-744-6086, as soon as possible.
                                                                                                                                     (1.1) with masking (1.2)




                                                                                                                                                                                                                                                   Electrodiagnostic Site
                                                                                                                                                                Visual Reinforcement
                                                                                           Tympanometry (1.2)




                                                                                                                                       AC & BC thresholds




                                                                                                                                                                                                          Auditory Processing
                                                                                                                Thresholds & Decay
                                        Case History (1.1)
   Audiological




                                                                                                                                                                                                                                                                            Electrodiagnostic
                                                                                                                                                                                       Conditioned Play



                                                                                                                                                                                                           Assessment (2.3)


                                                                                                                                                                                                                                Assessment (2.2)
                                                                                                                                                                  Audiometry (2.2)


                                                                                                                                                                                       Audiometry (2.2)
                                                                                                                  Acoustic Reflex
                                                             Otoscopy (1.1)




                                                                                                                                                                                                                                                      of Lesion (2.2)
                                                                                                                                                                                                                                  Aural Rehab
                                                                              OAEs (1.2)
Evaluation: initial & rate




                                                                                                                       (1.2)
skills & abilities observed
(year/semester skills
expected at rating of 1 or
2)
  Demonstrates infection control &
safety (D7)

   Demonstrates daily checks & use               NA
of equipment, supplies & manuals
(D17)
                                                 NA


                                                                    NA
  Determines whether
instrumentation is in calibration
according to standards (D18)
   Uses appropriate background
information to direct selection & use
of procedures (D2)

  Identifies purpose(s) for
procedure(s) (D7)

  Identifies various procedures that
might be used (D7)

   Identifies & uses cultural factors
in selection & use of procedures
(D6)
  Demonstrates client instructions
(D7)

  Demonstrates procedures (D7)

   Interprets, determines referrals &
recommendations, & documents
clinical data (D11, D12, D13)
   Effectively communicates about
procedures, results, implications
(D1, D14, D16)
   Demonstrates ability to self
critique competencies in this area
(D7)
   Other comments:
                                       Assistive Devices (3.2)
                                                                 Aural Rehabilitation




                                                                                                                               Screening (1.1)
                                           Amplification &
                                                                                          Audiologic




                                                                        (3.2)
  Audiologic                                                                            Prevention &                                               Audiology Prac
Management: initial &                                                                   Identification: initial &                                Foundations: init
rate skills & abilities                                                                 rate skills & abilities                                  rate skills & abilitie
observed                                                                                observed.                                                observed
  Uses instrumentation according to                                                       Interacts effectively w. patients,                        Demonstrates knowled
manufacturer specs. &                                                                   families, others during screening                        of patient characteristics
recommendations (E18)                                                                   programs (C1)                                            (B2)
  Determines whether                                                                      Prevents onset & minimizes                                Demonstrates knowled
instrumentation is in calibration                                                       development of communication                             of hearing impairment on
according to standards (E19)                                                            disorders (C2)                                           social/psychologic functio
   Effectively counsels &                                                                                                                           Demonstrates knowled
                                                                                          Identifies individuals at risk for
communicates prognosis &                                                                                                                         principles, methods & ap
                                                                                        hearing impairment (C3)
treatment outcomes (E1, E3, E4)                                                                                                                  of psychoacoustic metho
  Recommends, dispenses &                                                                 Uses culturally sensitive
                                                                                                                                                   Demonstrates electrica
services prosthetic & assistive                                                         screening tools for impairment &
                                                                                                                                                 (B11)
devices (E8)                                                                            disability/handicap (C4)
  Discusses prognosis & treatment                                                         Uses culturally sensitive screens
                                                                                                                                                  Demonstrates infection
options with appropriate individuals                                                    for speech, language & other
                                                                                                                                                 Universal Precautions (B
(E3)                                                                                    factors (C5)
                                                                                          Other comments:                                           Demonstrates cultural
   Develops culturally sensitive &
                                                                                                                                                 in identifying client/family
age-appropriate management
                                                                                                                                                 assessment & managem
strategies (E5)
                                                                                                                                                 (B18)
   Establishes & communicates                                                                                                                       Demonstrates knowled
treatment procedures, goals,                                                                                                                     compliance w. HIPAA, le
progress, & results (E13, E17)                                                                                                                   mandates, clinic policies
   Provides hearing aid, assistive                                                                                                                  Other comments:
device & sensory aid orientation
(E9)
   Monitors & summarizes progress
& outcomes with devices (E11)
   Documents procedures & results
in a manner consistent with
standards (E15, E16))

  Assesses efficacy of intervention
(E12)

  Collaborates with other service
providers in case coordination (E6)
  Other comments:
                                       FERPA Memorandum


To:   Audiology Doctoral Student Clinicians
From: Audiology Clinic Director
Re:   Family Educational Rights and Privacy Act (FERPA)

According to FERPA, information on student coursework and/or performance may not be shared
with individuals other than faculty members with a legitimate educational interest.

In the upcoming year, you may be placed at an off-campus audiology clinic. Off-campus
supervisors often ask for information related to coursework and clinical performance. The intent is
for the supervisor to determine if a student has the pre-requisite knowledge, skills, and abilities to
succeed at that placement site.

Please indicate below whether you will or will not offer permission to the Audiology Clinic
Director to share information from written documentation pertaining to your coursework and/or
performance. If you do offer permission, that permission will remain in force until one year after the
date on this signed form unless you formally request to change that and deny permission.

____ I do permit the Audiology Clinic Director to share information from written documentation
pertaining to my coursework, clinical activities, and/or performance in either area that is requested.

____ I do not permit the Audiology Clinic Director to share this information and I understand that
it may lead off-site clinical supervisors to refuse my placement at their site.


___________________________________
Student Clinician Signature

___________________________________
Date




                                                                                                    114
                                          ECU
                      Department of Communication Sciences & Disorders

                                Student Confidentiality Statement

I understand and acknowledge that as a student of ECU-CSDI that I have an obligation to protect
and keep confidential all patient data/information whether printed, written, spoken, or electronically
produced, and to access this information for appropriate and authorized purposes such as patient
care and records processing.

I understand that patient information must be accessed, maintained, and released in a confidential
manner. I accept complete responsibility for my actions, and I understand that any violation of the
confidentiality of patient information or unauthorized access may result in disciplinary or corrective
action up to and including immediate dismissal from the CSDI program for student misconduct. I
understand that each patient must sign a Release of Information form before any information is
mailed, faxed, or given to any party, including the patient or his/her parent.

I understand that I am not to discuss patient names, addresses and medical or financial information
with any individuals other than those who are directly involved with care of the patient. This
includes any public forum such as the classroom, clinical conferences, and seminars either on or off
campus. I understand that patients must sign consent forms before they can be videotaped,
audiotaped, or observed by any other party.


___________________________________
Date

___________________________________
Signature

___________________________________
Printed Name




                                                                                                  115
                                               DRAFT

PROCEDURES FOR ACCOMODATING STUDENTS WITH DISABILITIES ENROLLED
         IN CURRICULA REQUIRING PRACTICUMS/INTERNSHIPS

If a student will require accommodation, it is the student‟s responsibility to request accommodation
in advance. The unit offering the academic program should inform students how much advance
notice the unit requires to identify an appropriate internship/practicum placement and to make
arrangements for accommodations (e.g., one semester, one year, etc., before the
internship/practicum semester). The student may not have a sense of the internship setting and the
necessity for accommodation‟ therefore, the department should meet with the student one semester
prior to placement to apprise the student of the setting, thereby enabling the student to assess his or
her needs and initiate a request for accommodative planning. The student, the unit, and Disability
Support Services (A117 Brewster, phone: 252-328-6799) need to begin early (at least one semester
before placement) to plan for accommodations. Because it may be very difficult to know what
accommodations will be needed until the agency is involved, and because the nature of
accommodations may vary across agencies, units may prefer early agency involvement in
identifying needed accommodations.

The student and unity should seek a placement agency that (1) will provide an appropriate
educational experience, (2) will make reasonable accommodations for the student, and (3) will
negotiate with the student and the university to provide the services needed. (The Federal Office of
Personnel Management in Washington, DC publishes annually [near the end of April] a list of the
federal employer contacts and employing departments within agencies that consistently hire a large
number of disabled students. The list is available in ECU‟s Office of Cooperative Education.)

The student, the unit, and Disability Support Services should identify the accommodations needed,
including resources and adaptive/assistive equipment, in advance of negotiations with the placement
agency.

The student, the unit, Disability Support Services, the university legal counsel (2310Spilman,
phone: 252-328-6940), and the placement agency will develop a plan and negotiate
accommodations satisfactory to all parties. Placement agencies are also subject to Americans with
Disabilities Act (ADA) requirements and may have a contact person who is familiar with the
accommodations already being provided to agency employees. The agency ADA contact person
may be able to provide assistance in making arrangements for student placements.

The student must be an active participant throughout the process of identifying a placement agency
and identifying and negotiating accommodations. A fact sheet on common examples of
accommodations by category/type of disability will be appended to these procedures to assist units
in identifying and negotiating accommodations for students with disabilities and in preparing
contracts with placement agencies. This material might stimulate those involved in the
consideration of accommodations to think about the wide range of possibilities. (See attached
Suggested Accommodations.)




                                                                                                    116
Units are encouraged to discuss with placement agencies the need to provide accommodations for
student with disabilities and to identify, in advance of the need to find placements for students with
disabilities, what accommodations are available in agencies where they frequently place student
interns. Another aspect of a unit‟s preparation to accommodate students with disabilities may
involve identifying resources (interpreters, equipment, other agencies etc.) and creatively
considering opportunities to provide accommodations that are low cost, involve borrowing or
sharing equipment, etc.

Emergency Phone Numbers

       911 Emergency (Police, Fire, Rescue)
       Security    744-2247

Emergency Phone locations at the School of Allied Health Sciences

       Phone in each classroom
       Phone in lobby
       Blue lights designate phones in parking lot
       Library student patrol officers to escort to and from parking lot in evenings; 744-2219


Emergency Evacuation Plan

       When an alarm sounds, assume the emergency is real.
       Upon discovering a fire, immediately sound the building fire alarm if there is one and /or
       alert other occupants
       Call 911, giving your name, department, locations and telephone number.

Actual Evacuation

       Move individuals who need assistance to the designated Area of Rescue Assistance. Leave
       the area and notify the rescue personnel the location of these individuals so they can be
       rescued.

       When you evacuate, do not stop for personal belongings or records. Leave immediately
       using the nearest exit. Do not use the elevators. Close room doors behind you.

       Potential hazards should be secured if possible. Turn off gas supply for open flames.

       Evacuate to distance of at least 500 feet from the building to the designated area and out of
       the way of emergency personnel. Do not return to the building until instructed to do so by
       authorized personnel.

       Notify either the ECU police or firefighters on the scene if you suspect someone may be
       trapped inside the building.



                                                                                                    117
Appendix C
   No Support Documents at this time




                                       118
Appendix D

    Audiology Clinic Billing Procedures
    Hearing Aid Purchase Agreement




                                          119
                                 Audiology Clinic Billing Procedures

IDX, a computerized billing system, will be used in the front office to develop bills for our clients.
Those bills will be delivered to the ECU School of Medicine (SOM), and the SOM will generate
bills and collect fees from 3rd party payers and clients.

The new billing procedures do not apply to the following:
   1. research subjects if designated as “non-paying” in the IRB;
   2. CSDI students scheduled for course requirements---should be scheduled in the book as
      “Student Name; Course; No bill and no folder”;
   3. hearing aid clients who have a bundled hearing aid service plan through our clinic;

Under the SOM, there are no pro bono services scheduled through the clinic. Clients unable to pay
fees may call a number and apply for ECU Care and/or may be placed on a monthly payment plan.

When clients call in to the clinic for an appointment OR when they arrive, they will be asked to
provide demographic and insurance information. On an initial visit, they should be asked to come to
the clinic 15-20 minutes prior to their appointment so that all intake data can be collected and/or
confirmed.

The Audiology Clinic Bill/Encounter Form

The top of this form is to be completed by the Front Office.

Mandatory sections include:
Co Acct: contracted services not billed to client
Patient: name
Provider: SOM Physician
Perf Provider: Clinical Supervisor
Ref Physician/Agency:
Location: Belk 223
Svc Date: day of service

DOB:
Onset: if related to injury/stroke/incident
Auth #: insurance authorization number




Audiology Supervisors HAVE primary responsibility for PROCEDURES, DIAGNOSIS, AND
PROVIDER SIGNATURE:




                                                                                                  120
Many 3rd party payers WILL NOT REIMBURSE results of an evaluation when results are reported
as normal.

When possible, report diagnoses related to your test results.

If a diagnosis is likely or still to be ruled out, then you may code the condition as if it existed.

If results are normal, the chief complaint or suspected diagnosis should be reported as the primary
diagnosis.

Do not code previously treated conditions that no longer exist, although history codes may be used
as secondary if that condition may still impact the client‟s current status.

You are to make entries in the PROCEDURES, and DIAGNOSIS sections as follows:

    1. In the left column under PROCEDURES, rank order from 1 to x in terms of importance the
       procedures essential to the diagnosis or suspected diagnosis. Some insurance companies pay
       different rates based on these rankings. Do not mark any procedures that were not essential
       but that were performed only to assist clinician training.
    2. In the P column under DIAGNOSIS, rank the primary diagnosis as 1. And then rank any
       secondary diagnoses as 2, 3, and/or 4. WE ARE LIMITED TO 4 diagnoses.
    3. If a client is seen for a suspected condition/diagnosis or has had a condition/diagnosis and
       you find normal, then you may use the suspected or other condition/diagnosis (i.e., they
       have had middle ear fluid but are found to have normal hearing). Insurance companies will
       pay because they see that there was a basis for testing even though results came out normal.
    4. If there is no suspected condition and none is found, use the code V71.89 for “Observation
       of suspected condition ruled out” (e.g., UDS or ROTC).
    5. If there is no suspected condition but your testing revealed another diagnosis, then use that
       diagnosis code instead of this V code because V codes result in lower rates of
       reimbursement.
    6. The columns to the right of PROCEDURES, should be handled as follows:
            a. UM, unit modifiers---not used;
            b. FEE---written in by the front desk;
            c. DX, write the number(s) of the DIAGNOSIS that relate(s) to each PROCEDURE
                above;

Supervisors are to sign the form under “Provider Signature”.

                 The front office should fill in the fees and take care of co-payments.




                                                                                                       121
                           East Carolina University Speech-Language and Hearing Clinic
                                           School of Allied Health Sciences
                               Library, Allied Health and Nursing Building, Room 1310
                                              Greenville, NC 27858-4353
                                                     252-744-6104

                                     HEARING AID PURCHASE AGREEMENT

Name: ____________________________________                       MRNA #: ____________________________
Address: __________________________________ Telephone: ____________________________
          __________________________________
                                              INSTRUMENTS ORDERED
Manufacturer: ______________________________________________
Hearing Aid #1: _____________________________________________                                $__________________
                       Model                Serial #                               Ear
Hearing Aid #2: _____________________________________________                                $__________________
                       Model                Serial #                               Ear
Accessories: ________________________________________________                                $__________________
MFG. Warranty End Date: __________________                       TOTAL $__________________
Battery Size: ______________________ Balance Due on Delivery (≥50%) $__________________
                                                                 Remaining Balance Due $__________________
                                              Binaural Amplification Waiver
__________ I have been advised that binaural amplification has been recommended by the audiologist, but I prefer to
be fit with only one hearing aid at this time.
                                               Medical Waiver (if applicable)
                      (Medical clearance from a physician required for children under the age of 18)
__________ I have been advised by East Carolina University that the Food and Drug Administration has determined
that my best health interest would be served if I had a medical evaluation by a licensed physician before purchasing a
hearing aid. As a consenting adult over the age of 18, I do not wish to have a medical evaluation before purchasing a
hearing aid. To the best of my knowledge there are no conditions that would prevent me from using a hearing aid.
                                                    Terms of Dispensing
The hearing aid(s) is/are dispensed with a thirty (30) day trial period. If the hearing aid(s) is/are returned, you will be
reimbursed for the cost of the hearing aid(s), less the order and evaluation fee of $_______________. Custom made
accessories, such as earmolds, are not returnable.

For the lifetime of your hearing aid(s) we offer an in-office service warranty, which covers all adjustments, cleanings
and office visits.

Loss and Damage Insurance covering loss, theft and damage to the hearing aid(s) from causes other than normal wear
and tear expires __________, AND (if applicable) there is a deductible of __________ per aid.

Payment Plan (if any):
__________________________________________________________________________________.
       Signatures below certify that both parties have read, understand, and accept the terms of the agreement:
PATIENT: ______________________________________________________ DATE: _________________
AUDIOLOGIST/DISPENSER: ______________________________________ DATE: _________________
AUDIOLOGIST LICENSE#: ______________ HEARING AID DISPENSING LICENSE #: ____________




                                                                                                                        122
Appendix E


    Audiometer Check




                       123
   Audiometer Check: Initial & date
Inspection
checks
Power cord
Earphone cords
Insert earphone
tubing
Bone vibrator
cord
Headband &
cushions
Controls &
Switches (Amp.
Settings)
Listening
checks
Frequency &          R
interrupter
                     L
Attenuator
linearity            R
                     L
Transducer           R
cords
                     L
Cross talk           R
                     L
Known                R
threshold
                     L
Acoustic
radiation

Visual inspection:

Power cord: check entire length of power cord for wear, tear, exposed wires;

Earphone cords: check entire length for wear and tear;

Insert earphone tubing: check for cracking, tight and secure fit of tubing and connector, absence
of debris in tubing and connector;

Cushions and headband: check cushion, check tension of headband;



                                                                                               124
Controls and switches: all should be connected, all should be moved through entire range;
amplifiers set appropriately (at markings)

Listening check:

Frequency: Dial at 70 dB HL and present tones throughout the frequency range and listen for
steady pure tones without static, hum and with a clear onset and offset;

Attenuator Linearity: Set to 1000 Hz and present that tone throughout entire intensity range and
listen for changes without other noises;

Transducer Cords: Set to 1000 Hz at 70 dB HL and move and flex the cord along the entire length
and listen for static or intermittency;

Cross talk: Direct a 70 dB HL 1000 Hz tone to right earphone and disconnect that earphone
listening for cross talk in the left earphone; direct the tone to the left earphone and repeat the
procedure; tone should not be heard in the opposite earphone;

Acoustic radiation: Obtain BC thresholds at 2000 & 4000 Hz; Place earplug between vibrator and
mastoid and represent tones at threshold levels---if heard then this represents acoustic radiation;

Known thresholds: Check known AC thresholds and check to make sure unchanged by + 5 dB;
                  Check known SF thresholds and check to make sure unchanged by + 10 dB




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