Clinic Manual

Practicum

• Overview

Practicum: Therapy (Tx)

• Clinic Responsibilities and Expectations
  • Clinician Forms
    • Clinician Background Sheet & Schedule 
      • Download form, complete it, and email it to the Clinic Director
    • Clinic Compliance
    • Equipment Use Agreement
  • Clinic Forms
    • Authorization for Release of PHI to client/other 
    • Authorization for Release of PHI to Rees Clinic 
    • Client Agreement and Release
    • Telepractice Services Agreement and Release
    • Clinic Permissions and Notifications
    • Notice of Privacy Practice
• Clinic Processes
  • ITP - Intended Therapy Plan
    • ITP Instructions 
    • ITP Format
    • ITP Example
  • S.O.A.P. Notes
    • S.O.A.P. Template
      • S, O, A, P - Individual Example
      • S, O, A, P - Group Example
        • Consult with group program supervisor
  • TO/TS Format
  • Self Evaluation
  • STP - Semester Therapy Plan Format 
    • STP - Semester Therapy Plan Rubric
    • STP - Semester Therapy Plan Example
  • STS - Semester Therapy Summary Format 
    • STS - Semester Therapy Summary Rubric
    • STS - Semester Therapy Summary Example
  • Home Programs 
    
    • Home Program Format
      • Home Program Example-Adult
      • Home Program Example-Pediatric
    • Home Program Rubric

Practicum: Therapy (Dx)

• Practicum: Assessment (Dx)
  • Diagnostic Plan Format
  • Diagnostic Evaluation Report Format
  • Diagnostic Reevaluation Report Format
• Practicum: Audiological Assessment

Practicum: Internship 

• Practicum: Internship
  • Forms
    • Internship Planning Form 
      • Form submitted via Adobe Sign (SLHS to student to advisor to Clinic Director)
    • Certificate of Clearance Process for School-Based Internship
    • CBEST test information/registration

Clinic Policy Statements

• Essential Functions (under review)
• Background Check
• CPR
• Immunization and Vaccines
• Confidentiality/HIPAA
• Appearance
• Plagiarism
• Infection Control
• Equipment Use
• Mandatory Reporting of Child Abuse
• Grades
• Student Complaints
  • Department Chair: Dr. Elena Dukhovny, elena.dukhovny@csueastbay.edu 
  • Clinic Director: Shelley Simrin, (510) 885-4762 or shelley.simrin@csueastbay.edu