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Communication Disorders

Handbook for Clinical Practice

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Handbook for Clinical Practice

Appendix A - ASHA Requirements and Certification
Code of Ethics of the American Speech Language Hearing Association (ASHA)
Procedures for Complaints Against Graduate Education Programs
Standards for the Certificate of Clinical Competence
State Licensure Requirements for Speech Pathology and Audiology
State Educator's Professional License (Restriction: Speech Therapy) Requirements
Canadian Licensure Requirements
Standards/Speech Audiology Canada (SAC)
Application to the ND State Board of Examiners on Audiology and Speech Language Pathology
SAC (Speech-Language Audiology Canada) Clinical Hour Requirements
SAC Speech-Language Pathology Summary of Clinical Practice Hours form
MSU CDC Speech-Language Audiology Canada (SAC) Clinical Hours [Semester] Tracking form

Appendix B - ASHA Hour Forms
Weekly Log Sheet Guidelines/Example
External Practicum Hour Guidelines
External Practicum Hour Form
Semester Accumulation Print-Out Example

Appendix C - Evaluation of Student Clinician
Evaluation of Clinician's Performance
Remediation Improvement Plan Policy
Remediation Improvement Plan Policy Form

Appendix D - General Clinic Information
Memorial Hall Floor Plan
Media Center Information
Policy on Significant Infectious Diseases
Guidelines for Infectious Disease Control
Emergency Operations Guidelines
Case History Examples
  — Children's Speech Language, and Hearing History
  — Adult Case History
  — International Adult Speech/Language Questionnaire
  — Personal Attitude Scale for English Communication
Permission to Evaluate and Release Information
Permission to Videotape and/or Audiotape and Allow Student Observation
Videostroboscopy Consent Form
Flexible Nasopharyngoscopy Consent Form
Authorization to Release Records to MSU CDC
Application for Therapy
Confirmation of Refusal of Services
Dismissal of Services Form
CPT/ICD 10 Code Information
Class Schedule

Appendix E - Client Therapy Forms
Attendance Agreement
Checklist for Clinical Responsibilities
Client Contact Activity Log
Case Planner
Therapy Intake Interview
Current Medical Information
Plan of Care
Individual Lesson Plan
Master Lesson Plan Example
Group Lesson Plan
SOAP Note Template
Plan of Care Summary
Evidence Based Practice

Appendix F - HIPPA Inforation & Forms
HIPPA Inforation & Forms