Main Content

Clinic Manual of Operation

Manual of Operation 


Appendix A - Center Brochure

Appendix B - ASHA Code of Ethics

Appendix C - Confidentiality

Appendix D - Observation Guidelines

Appendix E - Observation Form

Appendix F - Fire and Medical Emergencies Policies

Appendix G - Articles on Infection Control

Appendix H - Audiology Billing

Appendix I - Diagnostic Billing

Appendix J - Billing and Payment Record

Appendix K - Fee Reduction Request Form

Appendix L - Therapy Session Feedback

Appendix M - Diagnostic Session Feedback

Appendix N - Speech-Language Pathology Practica Grading Sheets

Appendix O - Clinical Encounter Form

Appendix P - Mid-term Practicum Review Form

Appendix Q - Final Practicum Review Form

Appendix R - Speech-Language Pathology Student in Audiology Practicum

Appendix S - Clinical Support Plan

Appendix T - Clinical Clock Hour Summary

Appendix U - Student Evaluation of Clinical Supervision

Appendix V - Intake Screening

Appendix W - Audiology Follow-Up Appointments

Appendix X - Application Packet Materials

Appendix Y - Appointment Card

Appendix Z - Letter Requesting Information from Other Providers 

Appendix AA - Face Sheet

Appendix BB - Child Case History - Audiology

Appendix CC - Adult Case History - Audiology

Appendix DD - Adult Case History - Speech-Language

Appendix EE - Child Case History - Speech-Language

Appendix FF - Hearing Screening

Appendix GG - Authorization to Use Clinic Materials

Appendix HH - Pure Tone Audiogram

Appendix II - Serial Audiogram

Appendix JJ - Diagnostic Planning Worksheet

Appendix KK - Release of Information

Appendix LL - Report Cover Letter

Appendix MM - Therapy Reservation Form

Appendix NN - Standard Report Titles

Appendix OO - Diagnostic Report Format - Speech-Language Pathology

Appendix PP - Checklist for Processing Diagnostic and Audiology Reports

Appendix QQ - Client Files:  Order of Information

Appendix RR - Student Schedule Forms

Appendix SS - Session Plan Guideline/Example

Appendix TT -  SOAP Note Guideline/Example

Appendix UU - Chronological Summary of Activity

Appendix VV- Term Treatment Plan

Appendix WW - Communication Progress Summary

Appendix XX - Case Observation Form

Appendix YY - Inter-Center Referral Form

Appendix ZZ - CCD Staff Qualifications and Responsibilities

Appendix AAA - Non Contact / Modification Time Submission Form