clinic manual of operation

manual of operation image The Manual of Operation lists information and forms used at the Center for Communication Disorders (CCD).  Click on the links below to access PDF copies of the Manual and its appendices.

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