Audiology Clinic Handbook - Purdue University

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Audiology Clinic HandbookProcedural Manual to be used in Audiology Clinical PracticumM.D Steer Audiology and Speech-Language ClinicsDepartment of Speech, Language, and Hearing SciencesCollege of Health and Human SciencesLyles-Porter Hall715 Clinic DriveWest Lafayette, IN 47907-2038Telephone:(765) 494-3789Fax:(765) 494-0771Please note that COVID-19 protocols and procedures override many of the sections in this handbook. See COVID19 training and procedural materials for adjustments that will continue to be ongoing and revised for theforeseeable future.Revised Summer 2020

TABLE OF CONTENTSDescription of ServicesPurdue University Professional Protocol for Clinical PracticeProfessional Protocol NoticeASHA Code of EthicsASHA Scope of Practice in AudiologyModel Bill of RightsClinic FacilitiesMain Office and Front OfficeGraduate Student RoomMailboxesPatient Waiting RoomResource RoomPreschool Screening EquipmentComputer AccessElectronics and Technical SupportAdult Aural Rehabilitation RoomCopying PolicyKeysTelephonesHandicap AccessPatient ParkingParking ProceduresDirectionsMapClinical Practicum: General InformationGeneral GuidelinesProgression of Clinical AssignmentsClinical Practicum SequenceDress CodeTitlesAttendance PolicyLiability InsuranceSLHS Special Course FeeLogging HoursAnnual Crossroads ConferenceHIPAA/Risk ManagementClinic Procedures: Detailed Procedures and ProtocolsProgram Procedures (DDB, FS, GLASS, Hear Now, VR, etc)AssignmentsNo-shows/CancellationsScheduling PolicyClinic PreparationPatient Paper ChartsProcedures following the appointmentForms2 of 5151525353535454545455555555555656565757

Billing ProceduresSchedule of FeesFee Payment InformationAudiology Clinic Fee Program Flow ChartAudiology Clinic MaintenanceMalfunctioning EquipmentStart-upShut-downLegal Release FormsAcknowledgement of Receipt of Privacy NoticeLegal Release and Request for AdmissionDesignation of Individuals Involved in Treatment/PaymentConsent to Release Information FormAdvanced Beneficiary Notice (ABN)Medical WaiverMedical Examination FormEmail Consent FormPolicy on Medical ReferralsAudiology Clinic FormsCase History FormLegal FormsAudiogramsWord Recognition ListsEncounter NotesAudiologic Assessment ProtocolMaskingReport Writing ProceduresHIPAAMain Principles of Clinical Report WritingSuggested Professional VocabularyAssessing Documentation and Report WritingAcceptable Abbreviations for use in Patient FilesProtocol for Re-Assessment of Children and Adults with Hearing AidsPediatric Assessment ProtocolTelehealth ProtocolFirst Steps ServicesLion’s McKinney Hearing Aid ProjectGreater Lafayette Area Special Services (GLASS)Teaching ClinicsDisability Determination BureauHear NowHelp America HearHAAPIIN Vocational Rehabilitation ServicesAudio File ReviewGeneral Expectations in Clinic from ALL Clinical Instructors3 of 363656566666767687070767678818182828283858686

Hearing Aid ProceduresScheduling Procedure for Further EvaluationsHearing Aid/Earmold OrdersHearing Aid FittingHearing Aid CheckProcedures for Loaner Hearing AidsProcedures for Hearing Aid RepairsAural Rehabilitation ProgramsIndividualized Aural Rehabilitation ProgramsRehabilitative Auditory Communication Techniques (ReACT)Hearing Conservation Program - HCPCommonly Used Abbreviations in Hearing ConservationEvaluation of Clinical PracticumSupervision of PracticumClinical ConferencesEvaluation and Remediation Procedures for Audiology Clinic PracticumLines of CommunicationRisk ManagementHand WashingHandling ITE’s and EarmoldsToysDisposable ItemsInjury and IllnessAssociation InformationASHA: The American Speech-Language-Hearing AssociationNSSLHA: The National Student Speech-Language and Hearing Assoc.Purdue SAA: Purdue Student Academy of AudiologyISHA: The Indiana Speech-Language and Hearing AssociationAAA: American Academy of AudiologyADA: Academy of Doctors of AudiologyARO: Academy for Research in OtolaryngologyASA: Acoustical Society of AmericaCertification and endix of FormsSchedule SheetInfant ABR LetterAdult New Patient LetterCase History Form: InfantCase History Form: PediatricCase History Form: AdultAudiogramSample ReportsNames and Titles to be used on ReportsPolicies, Procedures, and Informed ConsentPrivacy Policy 14 of 108

Consent to Release Information FormDesignation of Individuals Who Are Involved in PaymentConsent to Release Information to Interpreter FromConsent for TelehealthAdvance Beneficiary Notice of Noncoverage (ABN) FormConsent to Email or Text for Appointment Reminders HearingAid Selection Agreement FormMedical Clearance FormHearing Aid AgreementAssistive Listening Device Purchase AgreementHearing Aid Repair RequestLoaner Hearing Aid AgreementHCP Purdue University Industrial Hearing Test FormHCP DefinitionsHCP Age Correction FormHCP Age Correction ValuesHCP Purdue REM Hearing Conservation Program FromHCP Hearing Protection Device Attenuation VerificationForm HCP Missed Appointment FormRequest for Occupational Medical ServicesDecision Tree STSPU Audiology Clinic Daily Feedback SheetsLocal PhysiciansFirst Step ServicesGLASS and Local Schools5 of 9150151152153154155157159159

Description of ServicesThe Audiology Clinic offers services to people of all ages, from infants to adults. The Clinic'sgoal is to improve communication through diagnostic evaluation and rehabilitative intervention.The initial contact with the patient is typically an audiological assessment to determine thehearing status of the patient and the extent of the problem. Based on the results of thisevaluation, and the patient’s needs, recommendations are made to the patient and his or herfamily regarding the avenues available for improved hearing and communication.The Audiology Clinic dispenses hearing aids and assistive listening devices (i.e., FM listeningsystems, personal amplifiers, telephone amplifiers, and alarm/warning devices). An in-depthorientation is provided to patients and their family members to insure the proper care and use ofthese devices, along with communication strategies to gain the most benefit within theindividual's unique listening environment.The Audiology Clinic provides the following diagnostic and rehabilitative services: Preschool speech, language, and hearing screeningsAdult hearing and speech-language screeningsHearing Conservation ProgramFirst Steps (birth to three) Programo Diagnostic hearing evaluation of infants and toddlersGreater Lafayette Area Special Services (GLASS)o Comprehensive pediatric hearing assessmentComprehensive adult hearing assessmentHearing Aid Program (for infants, children and adults)o Hearing aid selection, evaluation and fittingo Assistive listening device evaluation and dispensingAural Rehabilitation Programo Periodic off-site, on-site, and telehealth adult aural rehabilitationo Individual pediatric and adult aural rehabilitation (in conjunction with the SpeechLanguage Clinic)6 of 108

Purdue UniversityM.D. Steer Audiology ClinicProfessional Protocol for Clinical Practice -- Revised 2016A.B. C. D. E. ETHICAL PRACTICESConducts all clinical work in accordance with the Purdue University ProfessionalProtocol and the Code of Ethics set forth by the American epares for and conducts clinical services as assigned.Prepares for and conducts meetings/conferences/consultations (reviews charts, developsquestions and/or key points for discussion).Carries out all duties to accomplish total case management (e.g., forms, phone calls,referrals, etc.).Makes appropriate arrangements and notifies all concerned regarding anyschedule/location change or cancellation.PUNCTUALITYConducts clinical contacts within appropriate time frame.Begins and ends session promptly in order to allow sufficient time for clean up andsetting-up the next session.In case of student clinician illness, accepts responsibility to(a)Notify clinical instructor first(b)Discuss arrangements for make-up appointments with clinical instructor.When a patient is late, checks with appointment secretary to see if they cancelled. Thenchecks with clinical instructor. Never leaves the clinic without notifying/checking withclinical instructor first.Requests approval for absence from clinic in writing in advance of any anticipatedabsences from professional responsibilities.Submits all written assignments (e.g., test results, reports, letters, etc.) in acceptable form(appropriate grammatical usage, paragraph structure, punctuation, and spelling) byscheduled deadlines.Attends all meetings/conferences/consultations on time.CONFIDENTIALITYRetains any clinic paper charts in assigned locations in clinic, main office, therapy rooms,or graduate room.Utilizes discretion concerning patient information in written and oral communicationwith others.PERSONAL APPEARANCEUtilizes discretion in dress and behavior in professional activities.Wears name badge.Maintains and promotes a positive professional image.7 of 108

F. G. Does not wear ANY scented products (i.e., perfume, hair products, body lotions, etc.).Maintains proper personal hygiene.COMMUNICATIONUtilizes appropriate communication in all professional activities.Provides appropriate communication model for patient and family.Uses appropriate written and oral communication with all persons involved in the caseincluding clinical instructor, co-clinicians, and other professionals.Contacts clinical instructor regarding inability to complete work by designated deadline.Checks mailboxes at least once per day.ACCOUNTABILITYKeeps documentation (test results, data on specific goals, correspondence, release ofinformation, hearing aid status etc.) up-to-date in the patient's electronic chart.Reviews information in the Purdue University Audiology Clinic Handbook eachsemester.If exhibited behaviors violate these standards of our profession, the clinical instructor who deemsyour conduct as inappropriate will complete a Professional Protocol Notice. (See sample form onthe next page)Failure to meet these standards will result in probationary status to be determined by theAudiology Clinic Director and the Clinical Instructors directly involved. The result may also belowering of the semester clinical grade and/or termination of clinical responsibilities.8 of 108

Professional Protocol NoticeTo:, Student ClinicianFrom: , Clinical InstructorDate:On (date), youThis behavior is not consistent with the standards of clinical behavior at Purdue University’sAudiology Clinic. Please review the Protocol of Professional Behavior, and the Written andOral/non-verbal Communication Protocols described in the Audiology Clinic Handbook and theKnowledge and Skills Assessment in Calipso. If you have questions following that, please makean appointment to discuss them with me. You will be notified if a remediation plan is appropriateand we will meet to formulate this plan in consultation with the Director of Clinical Education inAudiology.Please review the Graduate Handbook which describes in detail Clinical Practicum Privileges,Policies and Implementation: Evaluation of Clinical Practicum Performance and Progress.Please indicate that you have read this memo by signing and dating it and leaving it immediatelyin my mailbox.Student ClinicianDateClinical InstructorDateCc: Jennifer Simpson, Director of Clinical Education in Audiology, Advisor9 of 108

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MODEL BILL OF RIGHTSfor People ReceivingAudiology or Speech-Language Pathology ServicesClients as consumers receiving audiology or speech-language pathology services have:1)THE RIGHT to be treated with dignity and respect;2)THE RIGHT that services be provided without regard to race or ethnicity, gender,age, religion, national origin, sexual orientation, or disability;3)THE RIGHT to know the name and professional qualifications of the person orpersons providing services;4)THE RIGHT to personal privacy and confidentiality of information to the extentpermitted by law;5)THE RIGHT to know, in advance, the fees for services, regardless of the method ofpayment;6)THE RIGHT to receive a clear explanation of evaluation results, to be informed ofpotential or lack of potential for improvement, and to express their choices of goalsand methods of service delivery;7)THE RIGHT to accept or reject services to the extent permitted by law;8)THE RIGHT that services be provided in a timely and competent manner, whichincludes referral to other appropriate professionals when necessary;9)THE RIGHT to present concerns about services and to be informed of procedures forseeking their resolution;10)THE RIGHT to accept or reject participation in teaching, research, or promotionalactivities;11)THE RIGHT, to the extent permitted by law, to review information contained in theirrecords, to receive explanation of record entries upon request, and to request correction ofinaccurate records;12)THE RIGHT to adequate notice of, and reasons for discontinuation of services; anexplanation of these reasons, in person, upon request; and referral to other providers if sorequested.Official Statement of ASHA Approved in 1993Please refer to https://www.asha.org/Code-of-Ethics/ for the most current version of the Code ofEthics.Please refer to http://www.asha.org/uploadedFiles/SP2004-00192.pdf for the most currentversion of the Scope of Practice in Audiology.47 of 108

Clinic FacilitiesMain Office and Front OfficeThe Main Office is located on the third floor of Lyles-Porter. The Department Head, GraduateSecretary, Assistant to the Head, Business Office, and faculty mailroom are located here. TheMain Office is open from 8:00 am to 5:00 pm Monday through Friday.The Front Office is located in room 1042. It is open from 8:00am to 5:30pm Monday throughFriday. The receptionists schedule patient appointments, check-in and check-out patients, sendreports, and fulfill other necessary functions related to clinic and the department.Graduate Student RoomLockers are available in room 3091A for student clinicians. The graduate student room is #2143.Patient paper charts may be taken to the graduate student room (#2143), but should never be leftunattended. Patient paper charts should never leave the building, but should be secured in theMain Office, Clinical Instructor’s office or designated file cabinet in the Audiology ClinicalAssistants’ office at the close of each day.MailboxesFaculty/staff mailboxes are located in the SLHS Mail Room located on the third floor of LylesPorter Hall in the main office. All graduate students are assigned two mailboxes at the beginningof each semester and these are located in the audiology clinic workroom (#2171) and in the EHRroom (#2143). Be sure to check your mailbox daily since your clinical instructor or office staffmay leave important messages for you here regarding patients, which need prompt attention. Usediscretion when leaving items of value in your mailbox.Patient Waiting RoomThe patient waiting room is located in Room 1042. Clinical discussions should not take place inin the waiting room. If important information needs to be exchanged with patients/parents, itshould be discussed in the privacy of a counseling room or test suite.Resource RoomThe Resource Room is located in Room 2161. Extra materials needed for play audiometry oraural rehabilitation may be checked out from the Resource Room. Materials must be signed outand returned promptly after use. Toys for play audiometry are also located in the AudiologyClinic workroom. Be sure not to exchange materials between the Audiology clinic and theResource Room.Preschool Screening EquipmentPreschool screening audiometers, tympanometers, screening kits, and dosimeters are located inthe audiology file room behind the clinic front desk (Room 1042). If you need to use one ofthese items, it must be checked out. Index cards in a black box on top of the cabinets are used toidentify the audiometer you are checking out, the date you are checking it out, and the date youreturn it.48 of 108

Computer AccessComputers will be available in the graduate student/electronic health records (EHR) room(#2143) and in the audiology workroom for clinic related work only.Electronics and Technical SupportThe Electronics & Technical Support Office is located in Room 3080, and supports theAudiology Clinic equipment set-up, maintenance, calibration, and repair. This is also whereequipment is stored, assembled, restored, and repaired. Equipment can be checked out for use ifneeded (e.g., TV cart, laptop, etc.).Adult Aural Rehabilitation Room/ALD RoomThe adult aural rehabilitation room is located in 2168. Assistive listening devices are stored inthis room. This room is used for small classes, meetings, and group adult aural rehabilitationsessions.Copying PolicyThere is a copy machine in room 2159 that is for clinic use only (i.e., patient audiogram).Personal copies of your materials or coursework needs to be copied at the undergraduate andHSSE libraries or the Purdue Memorial Union.KeysEach student clinician obtains keys to the building and clinic in the beginning of the firstsemester. This allows students access to the clinic facilities after hours.TelephonesThere are several telephones available for students to make local as well as long distance calls topatients (e.g., Audiology Clinic, Audiology Clinical Assistants Office, behind the receptiondesk). Campus telephone calls may be made by dialing the last 5 digits of the phone number. Allother calls can be made by dialing 7 followed by the phone number.AccessibilityThe Audiology and Speech-Language Clinics are accessible to individuals with disabilities. Anelevator is located near the entrance. Therapy rooms and audiology testing suites in the clinicare wheelchair accessible.Patient ParkingPatient parking is available on the first floor of the Harrison Street parking garage (attached toLyles-Porter Hall). Patients should make an immediate right when entering the parking garageand then proceed around the first floor to the parking spots designated ‘SLHS PPTRC Clinicparking only’. Patients can park anywhere in the garage that is not otherwise designated if theSLHS PPTRC clinic spots are full. Patients should then proceed through the double metal doorsand continue down the first floor hallway to check in at the front desk waiting area (on the left –room #1042).Parking ProceduresIt is the responsibility of each student clinician to ask the patient if they have parked in the spotsdesignated for visitors to our clinic and to prompt them to have the parking pass/ticket validated.49 of 108

DirectionsFrom Northern IndianaFrom Southern Indiana- I65 S to exit 193- Turn right onto US 231 S- Turn left onto US 52- Turn right onto US 231- Follow US 231 to Martin Jischke Dr.- Turn left onto Martin Jischke Dr.- Take the first exit off the round-a-bout, HarrisonStreet.- Turn left at the Lyles-Porter Hall-Parking Garagesign- Turn right into Parking Garage- I65 N to exit 172- Turn left onto State Road 26- State Road 26 turns into State Street- Turn left onto Marstelleller St- Turn right on Harrison street- Go straight throu

(a) Notify clinical instructor first (b) Discuss arrangements for make-up appointments with clinical instructor. When a patient is late, checks with appointment secretary to see if they cancelled. Then checks with clinical instructor. Never leaves the clinic without notif

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