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Clinic Intern Manual
Fall 2014
1 CLINIC MANUAL
Clinic Guidelines
National University of Health Sciences
200 E. Roosevelt Road
Lombard, Illinois 60148
www.nuhs.edu
Revised: August 2014 by:
Theodore L. Johnson, Jr., DC, MS
Disclaimer: The university reserves the right to make changes as required in course offerings,
curricula, academic policies, and other rules and regulations affecting students. Although this
manual intends to reflect current policies, rules and regulations, students are cautioned that
changes or additions may have become effective since the publication of this material.
2 Table of Contents
NUHS Mission and Goals .............................................................................................................. 5
Introduction .....................................................................................................................................7
Chapter 1: Rules and Regulations ...................................................................................................9
Chapter 2: General Clinic Rules ...................................................................................................19
Chapter 3: Charting .......................................................................................................................29
Chapter 4: Phlebotomy Procedure ................................................................................................39
Chapter 5: Patient Care .................................................................................................................47
Chapter 6: Outcome Disability Questionnaires ............................................................................57
Chapter 7: Clinic Disciplinary Protocols ......................................................................................59
Chapter 8: Incident/Accident Report Procedure ...........................................................................63
Chapter 9: OSHA Training and Compliance ................................................................................65
Chapter 10: HIPAA Training and Compliance .............................................................................79
Chapter 11: Business Office Procedures .......................................................................................85
Chapter 12: Clinic Community Outreach Events ..........................................................................87
Chapter 13: Clinical Clerkship Program ........................................................................................91
Appendix .......................................................................................................................................95
A – CCE Standard H: Educational Requirements for DC Program .............................................97
B – College of Professional Studies Competencies ....................................................................105
C – Quantitative Requirements for Graduation ..........................................................................107
D – Clinic Internship I Syllabus .................................................................................................109
E – Clinic Internship II Syllabus..................................................................................................115
F – Clinic Internship III Syllabus ...............................................................................................121
G – Abbreviations .......................................................................................................................127
H – DC Intern Weekly Tally Sheet .............................................................................................129
I – Equipment Damage and Repair Form ...................................................................................131
J – Clinic Outreach Record .........................................................................................................133
K – Clinic Community Outreach Hours Form ............................................................................135
L – Accident / Incident Report.....................................................................................................137
M – Supervisor’s Accident / Incident Report ..............................................................................139
N– Clinical Clerkship Qualifications & Application Requirements ..........................................141
O– Ancillary Clinical Experience (ACE) Basics ........................................................................143
P – Clinical Based Internship (CBI) Basics ................................................................................145
Q – Request for Independent Clinic Observation .......................................................................147
Student Intern Non-Solicitation Agreement ...............................................................................149
Signature Page ............................................................................................................................151
3 4 Mission Statement
Because:
• We value students as unique individuals seeking quality health sciences education through
our service and support;
• We value being progressive, knowledgeable, adaptable, original, and academically sound in
our academic programs;
• We value the substantive quality of our curricula through emphasis upon academic
excellence;
• We value progress achieved by the development of new knowledge and its importance to
chiropractic medicine and other complementary healing arts and sciences;
• We value quality training and practice in the clinical skills of all relevant programs with
particular emphasis upon the physician/patient relationship within the first professional
programs;
• We value complementary and alternative care for its emphasis upon holism and use of the
least invasive therapeutic procedures necessary for optimizing human health;
• We value collegiality and cooperation among all members of the University community, the
related professions, other health care systems, and the community;
Therefore:
The mission of National University of Health Sciences is to provide and promote the necessary
leadership, management and resources for the advancement of education, new knowledge,
outreach, and the ethical practice of the healing arts and sciences as taught within the programs
of this University.
Institutional Goals
I. By 2015, to continue development of a stronger financial position for the University.
II. By 2015, to develop and graduate physicians and other health care practitioners who,
because of the NUHS integrative education model, enthusiastically, confidently and
collegially promote integrative practice in their respective healing art and science.
III. By 2015, to continue expansion of educational program diversity.
IV. By 2015, to strengthen our position as a recognized, dynamic leader in education and
research germane to the primary care, “whole health healing” role of natural medicine
physicians and other health care providers.
V. By 2015, to develop, expand and promote greater cultural authority for our graduates.
Approved by the NUHS Board of Trustees, November 2011
5 6 Introduction
The Clinic Manual is the resource for general information regarding clinic activities, rules and
regulations that affects everyone. In order to maintain consistent behavior, appearance and
service, we ask that all students and clinicians abide with the standards provided in this manual.
During the last three trimesters at National University of Health Sciences, interns will receive
mentoring in a clinical setting. This is where students integrate the classes they have taken to
date. Through direct patient contact, interns grow into the role of a chiropractic physician. This
period is divided into three trimesters of outpatient operations.
The outpatient clinics are clinical settings under the authority of the Dean of Clinics and directly
overseen by the Chair of Clinical Practice. They are staffed by chiropractic physicians chosen for
their years of experience in a variety of settings.
Students entering the 8th trimester are gradually integrated into the clinic system and are
stepwise given increasing levels of patient care responsibilities, as determined by their
supervision clinician. They are rewarded with the inherent satisfaction of applying their learned
basic and clinical science knowledge and skills to patient care, while at the same time learning to
shoulder the concomitant responsibilities, in the role of student doctor. Even though the 8th
Trimester Clinic Internship is the first clinical setting in which the student doctor will function,
the demands and responsibilities are no less than in any of the subsequent internships in which
the student doctor or intern will have duty. Every effort must be made to develop the proper
attitudes, habits and skills necessary to effectively deliver health care.
During the 9th and 10th trimester internships, those skills developed during the prior trimester
will be used to treat patients from a broader spectrum of the general public. The clinicians will
continue to work to enhance and deepen the interns’ understanding and challenge them to
continue their growth. National University of Health Sciences wants its students to graduate with
the confidence that they have what it takes to be a successful doctor of chiropractic in every
sense. The clinics give interns that opportunity.
In the Appendixes of this document will be found the parameters of intern assessment,
requirements for graduation and the respective syllabi for the last three trimesters at National
University of Health Sciences.
7 8 Chapter
1
Rules and Regulations
These rules and regulations are designed to help the NUHS clinics run smoothly and efficiently.
Always remember that the clinics represent the largest area of public relations in the University.
The impressions that patients carry away about the University and the profession are determined
to a large extent by their experiences within the clinics and their environs. These impressions are
based in large part on personal interactions with interns, attending clinicians and office staff.
Attempts must be made to make these experiences as pleasant as possible. Everyone involved in
the clinic is expected to adhere strictly to clinic rules and regulations.
Professional Attitude
A positive professional attitude is an integral part of a chiropractic physician’s “armamentarium”
or tool kit, and it is essential that it matures during the intern’s time in the clinic. Professional
attitude is composed of many things, and is judged collectively under the category of
professional conduct.
Attitudes:
•
•
•
•
Toward colleagues and other professionals
Toward the patient/client
Toward the support staff
Toward other professional programs
Personal Hygiene
Keep the use of cologne or perfume to a minimum.
Dress
Patients prefer conservative rather than contemporary avant-garde styles.
Male interns are expected to wear a shirt, tie and clean well-pressed dress pants. Dress shoes or
boots are acceptable; sandals or sports shoes are not. Hairstyle and beard should be conservative,
clean and tidy. Beards can be grown on vacation, but should not be started while the intern is
assigned to clinic duties. Long hair must be pulled back and secured so as not to fall into the eyes
or interfere with rendering of treatment to the patients. Body piercing jewelry should be removed
when on duty, if possible. Otherwise, they must not be dangling or otherwise interfering with
patient care.
9 Female interns are expected to be dressed neatly; no jean style pants are permitted. Hem lengths
between mid-calf and 1" above the knee are acceptable. Spandex or other body-conforming
clothing is unprofessional and inappropriate in the clinics. Conservative necklines are expected.
Makeup should not be excessive. Hair should be clean and neat. If long, it must be tied back or
pinned up. Body piercing jewelry that is visible is to be of a conservative nature with no dangling
items.
All interns are expected to wear a clean, well-pressed, white, long-sleeved clinic jacket that
displays the intern’s name. The clinic jacket must be worn at all times when within the confines
of the clinic, and may be removed only when in a treatment room rendering treatment. The jacket
must be worn in any area where patients or the public may see the intern.
Well-trimmed and clean nails are essential.
Jeans, denim outfits, stretch pants, sweat-pants/shirts, and fleece materials, shorts, Spandex, and
similar outerwear are unacceptable.
The intern must follow all the dress code rules and it is the decision of the attending clinician if
the intern is appropriately attired for clinical duties. If not, the intern will be sent home
immediately and must make up the clinic shift at another time when they comply with the dress
code rules.
Smoking and Alcohol
Smoking is not permitted within the confines of the clinic. Interns shall not smoke immediately
prior to working with a patient. Alcoholic beverages are not permitted in the clinic. Interns shall
not consume alcohol prior to working with patients; clinicians are authorized to suspend interns
with alcohol on their breath from patient care. For further information, refer to the NUHS
“Alcohol and Drug Policy.”
Weapons
Weapons of any variety are not permitted in any part of the clinic.
Use of Telephone
Because of the large number of employees and interns using clinic facilities, it is necessary to
restrict telephone access for personal use. Personal calls on clinic phones for or by interns will
not be permitted except in emergency situations. Calls to patients concerning clinic business can
be made using a clinician’s telephone line, providing the clinician has authorized this. All clinic
phone lines have detailed logs, which track all calls. Any call on a clinic phone that is not
directly verifiable to patient care will be billed to the intern.
Nametags
Nametags are worn by all clinic personnel, including interns, so that all personnel are readily
identifiable. Intern nametags must not include the term Dr., DC, ND, or LAc. Acceptable
nametags include picture identification attached to the clinic jacket or an intern tag engraved by
an outside supplier.
10 Manners of Address
When speaking to a clinician, use appropriate speech for the nature of the relationship between
an intern and the doctor overseeing the care you provide. Use the more formal title when asking
a question of a clinician, i.e., “Dr. Smith, do I have your permission to treat my patient John as
we discussed?” Informal or more causal expressions are discouraged, i.e., “Hey Doc, what day is
the final?” The clinicians are not your peers, so the nature of your speech should reflect that fact.
When addressing an older or senior patient for the first time, it is respectful to address them with
“Ms., Mrs. or Mr.,” rather than “Jane or John.” Ask patients that you are seeing for the first time
what their address preference would be. This simple gesture could save you a lot of
embarrassment.
Business Cards
Since interns are working under the licensure of their clinician, the University provides clinicians
with business cards to distribute to their interns. The front of the cards contain the clinic name,
phone and fax numbers, the clinician’s name, and a line on which the intern can write their
name; the reverse side lists the NUHS clinics and addresses. These cards also serve as a tool for
the interns to use in patient recruitment.
The University does not allow the use of any other business cards by interns. Any questions
regarding business cards should be directed to the clinician and/or the dean of clinics.
Advertising
The University grants limited use of its logo, name and identifying information. This information
may not be used in any advertising without the expressed consent of the University. The Office
of the Dean of Clinics grants this consent. Each clinician must review all proposed advertising
and forward said copy to the Dean for approval. At no time will consent be given for individual
interns to advertise their services to any outside party, without the consent of the University. The
University will promote clinics within its system and not individual interns. Interns are not
allowed to advertise individually.
Patient Recruitment
Each intern is required to recruit patients to the attending clinician’s practice. The University
does not guarantee that each intern will see the same quantity or quality of patient. The
recruitment of patients by the intern is a valuable experience to be gained. The clinic system will
experience fluctuations in patient volume depending on economic factors, weather and normal
patterns, generally seen in private practice. It is imperative that interns learn techniques to recruit
patients throughout their internship. No one can guarantee what the marketplace will present at
any given time and the intern must be adaptable to those changes. The University will teach and
guide the intern through proper patient recruitment techniques.
Cellular Telephones
The University recognizes the need and convenience of cellular telephones. However, during the
duty shift, an intern may not have their cellular telephones turned on within the confines of the
clinic. They may use them outside of the clinical treatment room and most preferably, outside the
clinic building. Students should not talk on their cellular telephones in any clinic hallway nor
11 bring cellular telephones into treatment rooms with patients, to avoid them ringing/vibrating and
disrupting normal clinic activities. Cellular telephones must be turned off and/or not brought to
clinic preview and review sessions.
NUHS Whole Health Center - Lombard
Dean of Clinics:
Theodore L. Johnson, Jr., DC, MS
630-889-6513
[email protected]
Chair of Clinical Practice:
Manuel Duarte, DC, MS, MSAc, DACBSP, DABCO
630-889-6525
[email protected]
Clinicians:
Brian Anderson, DC
Denise Piombo, DC
Anna Jurik, DC
Tari Reinke, DC
Angie Skokos, DC
630-889-6464
630-889-6443
630-889-6823
630-889-6662
630-889-6459
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
630-889-6851
[email protected]
Clinic Services Manager:
Jean Fairbank
Clinic Hours:
Monday-Friday: 7:00 a.m. - 7:00 p.m.
Monday-Friday (mid-shift): 9:00 a.m. - 3:00 p.m.
Saturdays: 7:00 a.m. - 12:00 p.m.
Clinic Phone: 630-629-9664
Clinic Website: http://clinicalinfo.nuhs.edu
You will find forms of documents you will use in the clinic and an online Student Manual.
New Patient Visits—Lombard
Chiropractic AM Shift
The last appointment for which new or re-examination patients can be scheduled is 11:45 a.m.,
Monday-Friday. The front desk is to inform the new or re-examination patient that the
paperwork can be completed PRIOR to the initial visit (forms can be obtained online at
www.nuhs.edu); or, the new patient must be informed to arrive at the clinic 15-20 minutes prior
to their set appointment for the purpose of completing the paperwork. By having the paperwork
ready prior to the set appointment, more time will be made readily available for the patient and
clinician/intern.
12 During the initial visit, an intake will be obtained which will include a consultation and physical
exam. Depending on time constraints, lab and/or imaging may be performed as well. Any report
of findings and treatment will be discussed on the next visit.
Chiropractic Mid-Shift
The last appointment for which new or re-examination patients can be scheduled is 1:45 a.m.,
Monday-Friday. The front desk is to inform the new or re-examination patient that the
paperwork can be completed PRIOR to the initial visit (forms can be obtained online at
www.nuhs.edu); or, the new patient must be informed to arrive at the clinic 15-20 minutes prior
to their set appointment for the purpose of completing the paperwork. By having the paperwork
ready prior to the set appointment, more time will be made readily available for the patient and
clinician/intern.
During the initial visit, an intake will be obtained which will include a consultation and physical
exam. Depending on time constraints, lab and/or imaging may be performed as well. Any report
of findings and treatment will be discussed on the next visit.
Chiropractic PM Shift
The last appointment for which new or re-examination patients can be scheduled is 5:45 p.m.,
Monday-Friday. The front desk is to inform the new or re-examination patient that the
paperwork can be completed PRIOR to the initial visit (forms can be obtained online at
www.nuhs.edu); or, the new patient must be informed that he/she can arrive at the clinic 15-20
minutes prior to their set appointment for the purpose of completing the paperwork. By having
the paperwork ready prior to the set appointment, more time will be made readily available for
the patient and clinician/intern.
During the initial visit, an intake will be obtained which will include a consultation and physical
exam. Depending on time availability, lab and/or imaging may be performed as well. Any report
of findings and treatment will be discussed on the next visit.
Snow Schedule
The “Snow Schedule” applies in cases of inclement weather. Please check the website
www.EmergencyClosings.com or go directly to the University website: www.nuhs.edu where
information regarding a change in University and clinic hours will be posted on the homepage.
Emergencies
If an urgent need for care arises, the student should call the front desk in the Lombard Clinic at
630-629-9664 to make an appointment. The student will be seen in the clinic and an attending
physician will assess the need for care. Under no circumstances can the intern treat a patient
without the supervision of a clinician.
•
IF YOU HAVE WHAT YOU BELIEVE IS AN EMERGENCY – CALL 911 — OR GO
TO THE NEAREST EMERGENCY ROOM *
13 Caruth Health Education Center (Florida)
Dean of Clinics:
Theodore L. Johnson, Jr., DC, MS
630-889-6513
[email protected]
Chair of Clinical Practice:
Manuel Duarte, DC, MS, MSAc, DACBSP, DABCO
630- 889-6525
[email protected]
Clinician:
W. Scott Harrison, DC
727-341-3769
Clinic Phone:
727-341-3760
[email protected]
Clinic Services Manager:
Jean Fairbank
630-889-6851
[email protected]
Clinic Hours:
Monday: 8:00 a.m. - 4:00 p.m.
Tuesday: Noon - 7:00 p.m.
Wednesday: 8:00 a.m. - 3:00 p.m.
Thursday: Noon - 7:00 p.m.
Friday: 8:00 a.m. - 2:00 p.m.
Saturday & Sunday: Closed
NUHS Whole Health Center - Pinellas Park Clinic (Florida)
Dean of Clinics:
Theodore L. Johnson, Jr., DC, MS
630-889-6513
[email protected]
Chair of Clinical Practice:
Manuel Duarte, DC, MS, MSAc, DACBSP, DABCO
630- 889-6525
[email protected]
Clinician:
Mohsen Radpasand, MD (Iran), DC
727-873-7870
[email protected]
Clinic Hours:
Monday: 11:00 a.m. - 6:00 p.m.
Tuesday: 8:00 a.m. - 3:00 p.m.
Wednesday: 11:00 a.m. - 7:00 p.m.
Thursday: 8:00 a.m. - 3:00 p.m.
Friday: Noon - 6:00 p.m.
Saturday & Sunday: Closed
Weather Emergencies
Weather radios have been provided to each SPC college site to alert employees and students that
severe weather (thunderstorms, high winds and tornadoes) may be approaching. This system is
14 designed for early evacuation of portable buildings and similar vulnerable areas before the
approach of high winds, tornadoes or other severe weather. The radios receive weather warnings
and emergency broadcasts from the National Weather Service.
Tornado Safety
Tornado Watch: Conditions are favorable for tornados to form. If you are in a portable building
or trailer, prepare to relocate to a permanent building.
Tornado Warning: A tornado has been spotted in your area. Tornado warnings will be
announced by e-mail and verbal communications. When a tornado warning is issued, all
attention should be directed toward protecting life, not property.
1. If you are in a portable building or trailer, move to a permanent building.
2. Do not seek shelter in a gymnasium, auditorium or similar type of building with a freespa roof.
3. If you are on an upper level of a multi-story building, move to a lower level.
4. Stay away from exterior walls, doors, windows and items that might fall from above.
5. Move to an interior area of the building and take cover under a sturdy object or next to an
interior wall. Cover your head and face with your hands and arms.
Tropical Storm / Flood Threat / Hurricane Threat
When St. Petersburg College closes because of a tropical storm, rain or flooding, or hurricane
threat, the following activities must be completed by each department before releasing faculty
and staff:
1. Monitor the radio/television for additional information or call the college
information number at 727-341-4772 or 866-822-3978. Additional information can
be found at the SPC disaster preparedness site —
www.spcemergency.wordpress.com.
2. Back up computer hard drives. Secure disks, CDs and DVDs in zip-lock bags or move off
site.
3. Unplug computers, printers and other electrical appliances.
4. Move contents from bottom drawers of desks and file cabinets in case of flooding.
5. Move all equipment, books, papers and other valuables off the floor in case of flooding.
6. If necessary, relocate equipment, books, papers and other valuables off the floor in case
of flooding.
7. If relocation to a higher floor is difficult or impossible, cover and/or seal equipment and
other valuables with plastic.
8. In lab areas subject to flooding, store sensitive apparatus and glassware.
9. Attend to critical utility-dependent processes and make arrangements for back-up supply.
10. Ensure all hazardous chemicals and biohazard materials and wastes are properly
protected.
11. Check contents of refrigerators and set to coldest settings.
12. Empty trash receptacles of items likely to rot.
13. Take home all personal items of value.
14. Close and latch all windows. Close and lock all doors.
15 In addition, in case of a hurricane threat:
15. Move all equipment, books, papers and other valuables away from windows, off the floor
and to interior areas of the building. Be sure that equipment and other valuables that are
moved outside your office are tagged for easy identification and retrieval.
16. Clear desktops, tables and exposed horizontal surfaces of materials subject to damage.
17. Close and latch all filing cabinets.
Time Off
Each intern is allowed three (3) days per trimester of “release time.” The release time is not
cumulative and is forfeited at the end of each trimester if it is not used. This release time may be
used for any reason, such as: 1) personal time, 2) illness, or 3) licensure examinations. If
emergency or sickness occurs, it is the intern’s responsibility to either email or phone their
clinician and inform them of their absence. In this manner, appropriate accommodations can be
made or arranged for their scheduled patients.
Contact with the clinician must be made within 15 minutes of the start of the intern’s shift. If the
intern who will be absent that day does not notify the clinician within this allowed time, this will
be considered an “unexcused absence.” An unexcused absence requires 2 make-up shifts for
every 1 clinic shift that has been missed and considered unexcused. Furthermore, a shift must be
made up in its entirety from the beginning until the end, i.e., 7 a.m. to 1 pm. or 1-7 p.m., and
during a non-assigned shift. No partial hours will be allowed to be made up on various clinic
shifts. Finally only 1 missed seminar is allowed throughout the trimester. If the clinician is not
notified within the 15 minutes allowed time by the intern who will be absent that day, this will be
considered an “unexcused absence” and will require 2 hours make-up time. Again, make-up time
for seminars must be made up during a shift for which the intern is not scheduled.
Release time must be requested and signed off in advance by filling out a “Request for Time
Off” form. The forms are available from the clinician. The form must clearly identify the intern,
the date(s) requested, and make-up time (if required). Both the intern and clinician must sign the
form and a copy must be filed in the intern’s clinic performance file. When the make-up shift is
completed, the clinician must sign off next to the make-up date. Make-up shifts must be
completed within two weeks of the missed clinic shift. These personal days must be made up by
serving shifts at times other than those regularly assigned to that intern.
Additional time beyond the three non-personal days per trimester must be made up after the
Saturday prior to “Pink Slip Day,” unless other arrangements have been approved by the Chair of
Clinical Practice or Dean of Clinics. Pink slips indicating completion of requirements for exiting
the clinics (graduation) will be withheld until the additional duty is served. Extended absence for
military duty must be arranged with the Dean of Clinics or his designee.
Absences in access of the policies noted above will be reflected in the portion of the intern’s
clinic grade that addresses participation. Frankly, clinic is a “hands-on” experience that requires
interns to be present. It is contact with patients that makes the doctor, hence the strict rules
regarding attendance. More information concerning the participation section of the respective
syllabus for each trimester can be found at the end of this manual in the Appendix.
16 Special Clinic Support Assignments
The operation of a professional practice requires attention to a number of mundane daily tasks
that impact upon the public image and impression of the clinic. Support functions of this kind are
generally carried out at the beginning or end of each business day. At the discretion of the clinic
director, various support tasks may be distributed among all interns including laundry (washing,
folding and storing gowns and towels), discarding face paper after treating a patient, replacing
the face paper once it empties, etc. Your willingness to carry out these functions will also be
reflected in the degree to which you will be graded on participation.
Lombard Clinic Internship I Interns Only
A mandatory all-day trip and tour of the factory of Standard Process Inc. is scheduled for 8th Tri
students. The date will be announced to the class once it has been finalized. The bus ride
between Lombard and Palmyra, Wisconsin, takes approximately two hours each way. The bus is
equipped with a bathroom and air conditioning. Standard Process will provide lunch.
•
•
•
•
All students must ride the bus both ways.
All students must be on time for the bus, as the bus will leave at the designated time. The
bus will not pick up late students at any other location on the way to Wisconsin.
Dress is business casual, no shorts or tank tops.
While at Standard Process, professional decorum is expected.
Students must attend the Standard Process tour when their class is scheduled. If they do not
attend, they must make it up as an absence. If they attend the following trimester, they are
forgiven the absence. If they refuse to sign the waiver, they will sit in the cafeteria of the
Lombard clinic for the entire duration of the trip or be counted absent.
Florida Interns Only
NUHS/SPC interns participate in clinic lectures.
Intern Observations
Interns may choose to go on observations with doctors of their choice for a total of up to 10 days.
They may do so in their 10th trimester after all their clinical requirements for graduation are
completed, submitted and approved by their Clinician, the Clinic Services Manager, and the
Dean of Clinics.
Interns must complete the “Request for Independent Clinic Observation” form, which can be
found on the website: http://clinicalinfo.nuhs.edu or obtained from Clinic Services Manager
Jean Fairbank. A copy of the doctor’s license must be attached to the form. Deadline for
completion of observation paperwork must be completed by the third Thursday prior to
graduation. See Appendix R.
Pink Slip Day
Pink Slip Day is the same day as graduation rehearsal. Students must present their Pink Slip at
graduation rehearsal.
17 One week prior to Pink Slip Day, all graduating 10th Trimester students must check in
with Clinic Services Manager Jean Fairbank to make sure all Quantitative Requirements
for Graduation have been completed and received, and that all clinic accounts have been
paid. Note: Just because the ECQES requirements have been met does not mean that the
hard copy has been received by Jean Fairbank. Pink slips will not be issued until all
requirements have been met and paperwork received.
18 Chapter
2
General Clinic Rules
General Rules
The Clinic is the primary health care service for the students of NUHS. Eighth, ninth and tenth
trimester interns render care, acting at all times under the supervision and license of the attending
physicians. The Lombard Clinic is located on the main floor of Building B, the Howard-Schulze
Building and Clinic. The Florida SPC Clinic is located on the main floor of the Orthotics and
Prosthetics Building of the SPC Caruth Health Education Center.
Eligibility
All registered students of National are eligible for care in the Clinic. Additionally, the student’s
spouse and children are eligible to receive care. If the spouse or child of a student cannot come to
the Clinic during its normal hours of operation, they may be referred to the main clinic. Students
of NUHS and student dependents are eligible for complimentary treatment including chiropractic
adjustments and therapies and the first pair of orthotics. However, these individuals will be
charged for any procedures involving diagnostic imaging (i.e., X-rays are $5.00/film) and lab
work.
Services and Fees
A full scope of diagnostic and therapeutic services is available in the main clinic. Any patients
being seen in main clinic will be charged the normal fee schedule either directly or to their
insurance. See Route Slips in each location for details on services and fees.
Clinic Freshman Physicals – Lombard
A physical examination is required of all first trimester DC, ND and MT students. DC and ND
students must complete all aspects of this examination prior to registration for Trimester Two.
MT students may schedule an appointment in the main clinic with the approval of the Massage
Therapy Clinic supervisor. Part-time students in the Prerequisite Program or Bachelor’s Program
do not require a freshman physical. First trimester students presenting to the clinic are not
required to have completed the physical prior to care being instituted. They should be advised
that they need to complete the freshman physical in a timely manner, but they will receive care,
if needed.
The freshman physical examination consists of a comprehensive health history, a physical
examination (vitals, head, neck, eyes, ears, nose, throat, chest, abdomen, neurological, male
19 genitalia, female pelvic exam, and chiropractic spinal analysis) and a report of findings. A
urinalysis and complete blood count is required for student in the Doctor of Chiropractic
Medicine Program. Any CBC and UA performed for the purpose of the freshman physical is at
no charge; any additional lab work or X-rays may be recommended, if clinically indicated, at the
student’s expense.
For female students, a breast examination and genital/pelvic examination are part of the routine
freshman physical, however, a Pap smear is not unless clinically indicated. (Pap smears are
available if requested at University cost). If the student has had a breast and genital/pelvic
examination within the last year, or chooses to see another physician to have it completed, she
must have the doctor fax copies of the medical records including findings to the attention of the
Clinic at 630-889-6800.
Freshman Physicals – Florida
A physical examination is required of all first trimester DC students. DC students must complete
all aspects of this examination prior to registration for Trimester Two.
The freshman physical examination consists of a comprehensive health history, a physical
examination (vitals, head, neck, eyes, ears, nose, throat, chest, abdomen, neurological, male
genitalia, female pelvic exam, and chiropractic spinal analysis) and a report of findings. A
urinalysis and complete blood count is required for student in the Doctor of Chiropractic
Medicine Program. Any CBC and UA performed for the purpose of the freshman physical is at
no charge; any additional lab work or X-rays may be recommended, if clinically indicated, at the
student’s expense.
For female students, a breast examination and genital/pelvic examination are part of the routine
freshman physical, however, a Pap smear is not unless clinically indicated. (Pap smears are
available if requested at University cost). If the student has had a breast and genital/pelvic
examination within the last year, or chooses to see another physician to have it completed, she
must have the doctor fax copies of the medical records including findings to the attention of SPC
Clinic at 727-302-6610.
Supervision
The attending physicians at the University clinic are responsible for all decisions relating to the
care provided to the patients. The interns are under the constant and close supervision of the
attending and are permitted to perform only those procedures approved by the attending
physician. In addition, a detailed treatment plan must be completed within the same visit and
signed by the physician/clinician on shift. This insures continuity of care over the various
physicians who serve in the main clinic.
Any questions regarding health issues or management should be discussed with the attending
physician. Interns in the eighth, ninth and tenth trimesters are to provide recommendations and
care only under the attending physician and only in the University clinics. Care should not be
rendered in the dormitories, classrooms or any other sites.
20 Clinic Rules and Regulations
Clinic interns work under the attending clinician’s license. The patients are the responsibility of
the licensed physician.
On initial presentation with the patient, interns should bring a single sentence S (subjective) in
writing, on the progress note, to the clinician to begin the patient visit. For example: Patient
returns for continuing care of his elbow complaint and states that he is doing much better. More
history may be obtained and included in the subjective after the initial presentation to the
clinician. Interns SHOULD NOT complete an extensive history or start examination or treatment
without consulting with the clinician.
A Treatment Plan (green sheet) is needed in order to treat any condition. Therapies performed
are to be ONLY those listed on the Treatment Plan including manipulation to a specific area,
physiotherapy per the settings recommended and rehabilitation as recommended, and patient
education. Perform ONLY those things and everything listed on the Treatment Plan. Should the
plans need to be modified they should be discussed first with the clinician and changed on the
Treatment Plan.
Before commencing with treatment, patients should be informed of the condition being treated
and the treatment plan, and must consent to treatment. This is referred to as “report of findings.”
Prior to instituting therapy, the patient should be advised of the treating diagnosis, the treatment
plans, and goals. The benefits, alternatives and risks to care also should be discussed. Patients
should be asked if they have any questions. Finally, the patient must be formally asked they
consent to care. This whole process of informed consent must be completed prior to starting care
and should be recorded on the progress note and appropriate check boxes on the Treatment Plan.
If any time plans are changed, they should be recorded.
Patients should not be discharged without the clinician’s approval. The clinician needs to know
the status of the patient prior to discharge.
Interns should not write on the Treatment Plan unless instructed to do so by the attending
clinician. These issues should be discussed prior to writing in the patient’s file.
On the progress note, interns should record the EXACT treatment performed for that visit under
the Treatment Plan. Included should be: areas adjusted and techniques used; physiotherapy
applied with the specific setting used; specific rehab performed; any patient education given to
the patient during the visit or those to be explained in the future.
Essential HIPAA Compliance
On the initial visit to the clinic, the student must fill out a Financial/Treatment Consent form and
be provided a copy of the Practice Privacy Policy. The student must initial the portion of the
Financial/Treatment Consent form that states they have been provided with a copy of the
Practice Privacy Policy. The student should not be seen unless this has been accomplished. A
copy (yellow) of the Practice Privacy Policy is to be delivered to the main clinic desk at the end
of the shift, with the white copy placed in the patient’s file.
21 It is not appropriate for an intern to read a patient’s file if they are not involved in the case. Do
not discuss information with those not involved in clinic care. Do not discuss information outside
of clinic, or in classes where the patient’s right to privacy may be violated. Disciplinary actions
may result if the intern fails to comply.
Intern Reminders
•
Do not leave patient files unattended (especially in the patient’s room).
•
Do not examine or treat a patient through street clothes.
•
Clinic Route Slip – Lombard: An NUHS routing sheet must be filled out with each
patient visit. (See example in Appendix.) The main clinic desk will note the patient’s
name and date at the top of the sheet. The intern’s name and the clinician’s name must
added. Please record the therapy procedures rendered (CPT codes) and the diagnostic
code (ICD). Include the patient’s next recommended visit (NPV). The attending clinician
must sign. The intern should escort the patient to the front desk after the visit. The patient
must turn in the NUHS route slip at the main clinic desk at the end of each visit, and if
any services were rendered that require payment, handle prior to leaving.
•
Clinic Route Slip – Florida: An NUHS routing sheet must be filled out with each patient
visit. (See example in Appendix.) The intern needs to note the patient’s name and date at
the top of the sheet. The intern’s name and the clinician’s name must be included. Please
record the therapy procedures rendered (CPT codes) and the diagnostic code (ICD).
Include the patient’s next recommended visit (NPV). The attending clinician must sign.
The intern should escort the patient to the front desk after the visit. The patient must turn
in the NUHS route slip at the main clinic desk at the end of each visit, and if any services
were rendered that require payment, handle prior to leaving.
•
Outcome Assessment Form: Patients must fill out the appropriate outcome assessment
form(s) prior to beginning the history and exam. This must also be done at every reevaluation and with a new chief complaint, which will then go into the patient’s file.
•
Intern Tally Sheets: Intern All NUHS interns are required to keep their clinic numbers
recorded on Tally Sheets. Tally Sheet forms can be found on http://clinicalinfo.nuhs.edu.
All Tally Sheets must be readable, and all back-up paperwork needed to support the work
done must be attached. Back-up paperwork cannot be handed in after the Tally Sheet has
been entered into ECQES. See Appendix G.
The intern is responsible for the accuracy of this record, and entering the data from the
tally sheet into ECQES on a weekly basis. After the intern has entered the data, they
should submit their tally sheet to their clinician. The clinician will electronically review,
modify, and except the tally sheets weekly. After the clinician has accepted the tally
sheet, it will be submitted to the Clinic Services Manager, Jean Fairbank, for record
storage. Periodic audits of intern tally sheets will be performed to ensure accuracy of
ECQES data.
22 All NUHS interns will receive the information on how to enter their tally sheet data into
ECQES at the beginning of Clinic Internship I (eighth trimester). This will be the same
logon information, as they will need for the Audit system.
Protocols
•
Only those techniques taught in the core curriculum at the National University of Health
Sciences are to be used in this clinic.
•
Universal Precautions are to be exercised at all times. (Please refer to Infection Control
Procedures in the Clinic Manual or check with the NUHS OSHA compliance officer.)
•
Interns should not leave the clinic area without notifying the attending clinician.
•
Interns should not leave the clinic until the patient’s file(s) has been completed.
•
Interns should sign out under THEIR OWN NAME at the end of the shift with the
clinician’s approval.
•
Interns should not treat any patients without informing the attending clinician.
•
Interns should be prompt for their scheduled shift and arrive a few minutes early, if
possible. Patients can be seen more promptly if the intern is prepared for the visit. Intern
evaluation sheets may reflect tardiness as an unacceptable behavior.
•
Interns should not attempt to erase or “scratch out” any item in a patient’s file. Items to
be deleted should have a single line placed through them and initialed. Anything that may
have been “forgotten” may be added after the initialed SOAP note as an “addendum.”
Interns should be sure to complete the SOAPs in a timely manner, the same day of the
visit, preferably before the end of the shift.
•
Interns should remember when writing progress notes: if it is not recorded in the file you
didn’t ask it, test for it, or do it.
Duty Intern
A Duty Intern is scheduled daily, Monday through Saturday, for each shift during clinic hours.
The primary responsibility of the Duty Intern is to help promote positive relations between the
patient and clinic. It is also felt that exposure to front desk operations will provide interns with
valuable experience when it comes time to organizing the front desk area in their own offices and
help them understand the need for orderly patient flow. Duty Interns cannot see nor treat patients
that day.
Duty Intern responsibilities include:
1. Arriving 10 minutes early;
2. Locating patient charts in Medical Records, and asking for the charts from the assistants
in medical records;
23 3. Annotating any special equipment or treatment room needs (flexion/distraction table,
etc.);
4. Greeting each patient in reception area;
5. Escorting the patient to the appropriate room;
6. Telling the patient to open the door slightly when gowned and ready;
7. Notifying clinician of patient’s arrival;
8. Being available to assist Front Desk/Support Staff when not escorting patients;
9. Noting in the medical file if a patient reschedules or did not keep his/her appointment and
producing a Recall List at the end of the shift;
10. Bringing phone messages and rescheduling notes to a clinician as soon as possible;
11. Checking the intern room for neatness at the end of shift, sanitizing tables between
patient visits and reminding colleagues to clean, if necessary, for the next shift.
12. Checking the patient rooms to be sure that there is lotion, gloves, tongue depressors, and
any other pertinent supplies that may be required for use by the treating intern, and
making sure the supplies have not expired.
13. Returning all charts to medical records at the end of the shift. Making sure that all charts
are printed and signed by the treating intern, followed by a signature of the clinician.
Making sure that the charts of patients who did not keep their appointments have been
documented and signed by the clinician.
14. AM Duty Interns will pull all laboratory reports from the printer in the lab and sort by
clinic and physician. A copy of each report is kept in the lab and filed in the appropriate
clinic's folder. The Duty Intern will place all lab reports in the clinic mailbox and deliver
reports to each Lombard clinician.
15. Anytime during the shift, the Duty Intern is to go to the lab, and each and every one of
the treatment rooms located in the DC, ND, and AOM rooms of the clinic, and replace
any filled biohazard red bins with new, clean bins, which are found in the storage room.
The filled red biohazard containers should be sealed shut and placed into the biohazard
boxes found in the lab. Be sure to ask the assistant(s) in Medical Records to unlock the
room for the new biohazard bins, which are to be replaced in the room that had the
previously filled biohazard bin.
Remember: The primary role of a Duty Intern is to ensure maximum convenience to the patient.
Courtesy is paramount. When greeting patients, the Duty Intern should use the following script:
“Mrs./Mr. (etc.), I am intern _________. Dr.__________ will be able to see you in a moment.
Please follow me.”
If for any reason there is a disturbance, direct the patient to an available empty consultation room
and summon the clinician or business supervisor immediately. The Duty Intern must not discuss
the patient’s clinical condition. (Do not start a conversation with "How are you?" for example.)
The Duty Intern must not discuss patients with staff; patient information is confidential. The
Duty Intern must not make comments about patients, staff, interns, NUHS, policies, etc., in
public areas.
24 Laundry Duties – Lombard
Student Clinic has been given the responsibility of doing the clinic laundry on Mondays and
Wednesdays. Main clinic performs this task on Tuesdays, Thursdays and Fridays. Laundry duties
include washing, drying and folding any laundry from these days on both shifts. This applies to
folding laundry found in dryers on Wednesday and Friday morning. Below are instructions for
the clinic laundry.
•
Use the grocery carts or gown and towel carts to gather all gowns and towels located in
the bins in the hallway by the PT room.
•
Take the dirty laundry to the basement. Turn left out of the elevator and go to the laundry
room #102.
To wash laundry, there are three washers. Two are silver commercial washers (first and
third in the line of machines). For these two washers, just place laundry in the washers
and press Start. Soap is automatically added!
•
For the standard washer (white washer in the middle of the line of machines), add one
teaspoon of soap. The soap is in a 50-gallon drum on the right when you first walk in the
room. Push the pump on the drum until the soap comes out. Be careful in case the blue
soap splashes. Do not wear your white coat when dispensing soap!
The washers all take about 20 minutes. Never leave wet laundry in the washers at the end
of your shift!
•
To dry laundry, set the drying time to 50 or so minutes and set the cooling time to 15
minutes to prevent overheating! Dry the gowns and towels separately.
•
Fold the laundry when it’s done and put towels and gowns back in the spaces provided in
the clinic halls.
•
Note: Massage Therapy and AOM are responsible for their own laundry and responsible
for returning their sheets or blankets to their hallways.
Laundry Duties – Florida
The Florida clinic uses an outside laundry service. Interns need to sort used laundry into separate
bags for gowns and towels. After laundry is returned, interns must restock the rooms with items.
Working with Medical Records
Lab work:
•
•
•
Interns must have a route slip for the student initialed by the clinician.
If the student has never had lab work done previously, the intern will need their birth
date.
The intern must go to Medical Records first to pick-up the labels and requisition form
before they begin any lab work on the student.
25 •
•
•
The intern will need to know the name(s) for the test(s) they want to conduct. Medical
Records can look up the price and CPT code.
o If a test is not found, Medical Records or clinicians can check with the lab. Interns
may not call the lab.
o On the route slip, the Medical Records will always write the full amount.
o Students pay half.
If supplies are running low in the lab, interns must inform Medical Records.
If there is a test that needs specific supplies, they can be ordered and should be arrive in
about two days. Interns must inform the clinician and Medical Records.
Supplements – Dispensary:
•
•
•
•
•
Supplements can only be purchased by students, who are under a clinician’s care and
currently being seen in the clinic.
The dispensary is now on an electronic scanning system. All supplements need to be
scanned by a designated dispensary clerk or someone from Medical Records. NO
SUPPLEMENTS MAY LEAVE THE ROOM WITHOUT BEING SCANNED.
SUPPLEMENTS CANNOT BE TAKEN FROM THE DISPENSARY TO SHOW TO A
PATIENT OR CLNICIAN. After the supplements are scanned, the name, price and
quantity of each supplement will be written on the route slip.
Refunds are given only on non-refrigerated items if they are returned within 7 days from
the date of purchase. Refunds cannot be given on refrigerated items.
Make sure the patient is willing to try the supplement before selling it to them. Multiple
refunds to an individual patient will not be tolerated.
Should an intern require a special supplement that is not in the dispensary inventory:
o Their clinician must give approval to order the supplement;
o Pre-payment must be received from the patient before the supplement is ordered;
o The clinician is the only person who can give the special supplement to the person
who orders the supplements.
Files:
•
•
•
•
•
The Duty Intern picks up all files for their shift.
If someone adds to the schedule, the Duty Intern will need to complete an Out-Guide slip.
o The file number is the student/patient’s last name first, then the first name.
o Their clinician is the clinician for that day.
o The intern is the name of the intern who is seeing the student.
o The date is the day the file is being removed.
Some students go by different first and/or last names. If a student’s chart cannot be
found, look under a married name or maiden name.
If a student patient is a student dependent, Medical Records must be informed.
Should a patient request copy of their X-ray report, lab work, or any part of their file,
they must sign a Medical Release form that can be found at the front desk. Please refer to
the front desk receptionist for such a form prior to giving out the requested documents.
This also applies to any medical information to be sent to any other individual requesting
medical records.
26 Equipment:
•
•
•
•
All equipment must be signed out at the Medical Records window.
The Equipment Sign-out sheet includes:
o Date
o Equipment removed
o Intern/clinician’s name
o Time removed
When finished with equipment, it must be returned and the return time noted on the sheet.
This applies to things such as the male/female models for proctologic or gynecology
mock exams, icthemol, ear lavage equipment, acupuncture electric stimulation units, and
anything that is found in Medical Records that requires signing out.
If a piece of equipment does not work properly, you must do the following:
o Tell Medical Records the piece of equipment is not working. Fill out an “Equipment
Damage & Repair Form” found on http://clinicalinfo.nuhs.edu. See Appendix I. Have
your clinician sign the form and put the original in the mailbox of the Administrative
Assistant to the Dean of Clinics, Vicki Shargo.
27 28 Chapter
3
Charting
Integral to good patient care is a system of record keeping which insures that all aspects of a
clinical encounter is notated and consistent care can be rendered visit to visit. There is also the
medical/legal aspect to documentation. This chapter reflects the evolution of charting at National
University of Health Sciences, with an emphasis on a “whole person” concept of primary health
care. With this in mind, here are the essential components of a chart:
• History
• Chief Complaint / Presenting Illness
• Family History
• Review of Systems / Past Medical History
• Physical Exam
• Laboratory Evaluation
• Treatment Plan, including diagnosis
• Report of Findings: A report on the patient’s overall health status
• Progress Notes (SOAP)
Here are some examples of the components noted above being considered in a variety of
scenarios:
• A family history of CV disease & a poor diet, which may generate a need for some life
style changes.
•
A history of chronic mid-scapular pain and thoracic postural abnormalities noted on
physical exam, which may be amenable to chiropractic care.
•
A family history of thyroid disease, history of chronic fatigue, and intolerance to cold
may generate thoughts for further evaluation of the patient’s thyroid.
•
A history of fatigue, and glucose noted on the urinalysis should generate some thoughts
for further evaluation.
o A report on the lab work that was done should include a brief description of the test
and what was learned. (Results should not to be reported as, “Your blood and urine
are OK.” Consider reporting results in the following manner. “CBC: “These results
rule out anemia and infection.” UA: “ These results speak against bladder, kidney
problems.”
29 Abnormal findings may generate an entry on the Treatment Plan and/or the Chronic Problem
sheet to address prevention of disease and care for conditions. In some case, the information
gathered may trigger an entry on the Contraindications sheet (the top half of the Chronic
Problem sheet). An example of this would be:
• The patient is wearing a cardiac pacemaker. Interferential current would be deleterious in
the extreme to this patient.
• A DEXA scan shows that the patient has marked osteoporosis. High velocity manual
manipulation would in all likelihood cause a fracture and therefore should not be
performed.
Incomplete Data Base: Once the incoming student has begun the evaluation, it is noted in the
SOAP note for that date that the patient has an Incomplete Data Base (IDB). Until the report of
findings has been given, this status will be in effect. When the IDB has been resolved, there will
be another note in the record to reflect that fact. In all likelihood, the patient may be given a
report of findings following the completion of the database.
A patient presenting for a freshman physical that does not have a CC/PI will only need one
sentence on the progress note stating: “Pt. presents for Freshman Physical, denies CC/PI.”
When a patient has presented for a physical exam and also has an active problem for which they
are seeking care, a precise description of that problem is written on this page. Use complete
sentences, writing in paragraph form. Place the data in chronological order.
Include the following:
• Description of the onset and course of the problem
• Location of the primary discomfort/problem and any radiation/referral of pain
• Type of discomfort
• Aggravating and relieving factors
• Associated manifestations or constitutional symptoms
• Previous treatment, including efficacy
THE HISTORY
Before beginning, insure the patient completes the Comprehensive Medical History form. Then
in person, explore the details of their chief complaint, prioritizing from the most pressing
concern and working towards those items with which they have less perceived unease. This is all
documented on the front of the Chief Complaint/Hx of Present Illness form.
Site
Notice that on this form there is a small text box. This list of the various
Intensity
types of inquiries should act as both a starting point and give a checklist to
Quality
insure that an essential line of questioning is not missed. On the other hand, Onset
this list alone does not constitute all that is required to complete an in-depth Radiation
Aggravating Factors
history. Remember that each answer the patient gives opens up a whole
Alleviating Factors
Associated Manifestations
realm of other associated questions. An example would be asking the
patient about an injury that occurred at work, which should then evoke a
detailed description of the nature of their occupation and the challenges inherent in that work.
30 Once this is completed, move on to covering every positive response to the questions framed by
the Comprehensive Medical History form, item by item. This gives you a chance to “connect
the dots,” for not only do you need to follow up on any marked item, but also question in more
depth those areas where, as a physician, you perceive a connection between a set of symptoms
and possibly systemic dysfunctions. . There are also named items on the backside of this sheet to
look at other general health related questions.
If the patient is coming in for a freshman physical and presents with no chief complaint, first
explore their lifestyle choices. This includes diet, exercise and sleep, how they are handling
stress, and recent major life changes in enough detail to understand ways that you might improve
their health during their tenure at the University. When you go onto the Comprehensive
Medical History form, you may find that they indeed do have a recurrent or chronic complaint,
but have become so acclimatized to its possible low-grade presence that they do not think to
mention this issue in a health care setting. On the other hand, for at least half of our students, the
care they receive from one of our interns is the first time they have been under chiropractic care.
They may be unaware of the broad scope of what we treat as a profession, therefore discount
health concerns, not knowing what might fall within the chiropractic scope of practice.
Lastly, there is the Adult Preventive Health Record (APHR)form. This form allows you to
record key examination procedures, which regardless of which profession is providing health
care, should be checked on a regular basis as indicated. This form also includes various risk
factors and the time you as the provider asked about them. Education is an essential element of
the service we provide. A “whole person” approach to health care must include informing the
patient of practices and behavior that could prove deleterious to them. The front of the chart
should be stamped with the APHR grid, and the date of each exploration of this topic should be
noted.
THE PHYSICAL EXAMINATION
When completing the physical examination, use the Comprehensive Exam 1 & 2 sheet to keep
track of your findings. Remember to minimize patient movement. The form has been laid out to
insure you are efficient in time management. You do not want your patient to have to stand-up,
sit down, roll over, and then stand up again! It is disrespectful of the patient, they may be in pain
and cannot tolerate all this movement, and your behavior will make you look like a disorganized
amateur.
When you have completed the examination you can take the information which you collect on
the Comprehensive Exam 1 & 2 and write notes in the O: section of the SOAP note for this
visit, outlining the highlights or positive findings of this process in summary. An example of this
might be as follows:
S: PP for initial visit evaluation for LBP of several years duration. See Hx form dated today
for more details. Pt complete pain chart with analog pain scale. VAS=3-5/10, Oswestry
LB=54
O: Performed both physical exam and lumbar regional (see forms dated today for details).
Exam findings significant for the following: decreased L/S ROM; increase BP at 135/98
31 right; decreased gluteal strength both maximus and medius 4/5 b/L; provocative Kemp’s with
non-radiating to the L4-S1 region; pain, palpable and tender b/L psoas muscle; and, mild
Trendelenburg hip drop during gait.
A: Based upon Pt’s symptoms and physical exam findings, Pt’s distress arising from facet
syndrome, psoas myofascial pain syndrome, gluteal muscle weakness, and segmental
dysfunction L/S.
P: See treatment plan dated today for details of care. Presence of osteoporosis as noted on
DEXA scan from Jan 11, 2006, dictates low force technique be used with no HVLA.
If you were not able to complete the examination on a given day it is still important that you
complete the objective portion of your SOAP note for that visit, showing what you did
accomplished. From a medical / legal standpoint, if you pick up the examination on another day,
show which sections of the Physical or Regional Examination form(s) were completed when.
Draw a line, date it and indicate that all material that followed afterwards was completed at
another time. Of course, the Physical and/or Regional Examination form(s) remain part of the
record.
Correct File Order
The various parts of the patient’s file are placed in a specific order. Following is a diagram
showing the correct placement of clinic forms.
Note: When the file is opened, the two files that should be immediately visible are the Problem
List on the left side and the latest Daily Progress Note (SOAP) on the right side.
32 THE PHYSICAL EXAMINATION
When completing the physical examination, use the General Examination Findings sheet to
keep track of your findings. Remember to minimize patient movement. The form has been laid
out to insure you are efficient in time management. You do not want your patient to have to
stand-up, sit down, roll over, and then stand up again! It is disrespectful of the patient, they may
be in pain and cannot tolerate all this movement, and your behavior will make you look like a
disorganized amateur.
When you have completed the examination you can take the information which you collect on
the General Examination Findings and write notes in the O: section of the SOAP note for this
visit, outlining the highlights or positive findings of this process in summary. An example of this
might be as follows:
S: PP for initial visit evaluation for LBP of several years duration. See Hx form dated today
for more details. Pt complete pain chart with analog pain scale. VAS=3-5/10, Oswestry
LB=54
O: Performed both physical exam and lumbar regional (see forms dated today for details).
Exam findings significant for the following: decreased L/S ROM; increase BP at 135/98
right; decreased gluteal strength both maximus and medius 4/5 b/L; provocative Kemp’s with
non-radiating to the L4-S1 region; pain, palpable and tender b/L psoas muscle; and, mild
Trendelenburg hip drop during gait.
A: Based upon Pt’s symptoms and physical exam findings, Pt’s distress arising from facet
syndrome, psoas myofascial pain syndrome, gluteal muscle weakness, and segmental
dysfunction L/S.
P: See treatment plan dated today for details of care. Presence of osteoporosis as noted on
DEXA scan from Jan 11, 2006, dictates low force technique be used with no HVLA.
If you were not able to complete the examination on a given day it is still important that you
complete the objective portion of your SOAP note for that visit, showing what you did
accomplished. From a medical / legal standpoint, if you pick up the examination on another day,
show which sections of the Physical or Regional Examination form(s) were completed when.
Draw a line, date it and indicate that all material that followed afterwards was completed at
another time. Of course, the Physical and/or Regional Examination form(s) remain part of the
record.
Correct File Order
The various parts of the patient’s file are placed in a specific order. Following is a diagram
showing the correct placement of clinic forms.
Note: When the file is opened, the two files that should be immediately visible are the Problem
List on the left side and the latest Daily Progress Note (SOAP) on the right side.
33 LEFT SIDE
TOP OF FILE
RIGHT SIDE
TOP OF FILE
Problem List
SOAP
APHR
Exam
Med List
CC/PI (Hx/pink form)
Problem Management / Treatment Plan
Hx Follow-up
Miscellaneous Forms:
Labs
Imaging
Release form
Demographics
Consent
Copy of Insurance Card
Patient Information Form
Comprehensive Hx
Outcome Assessment Forms
including SF-12
The right side of the chart is
grouped by date, NOT BY
COLOR. Example: SOAP
11/5/13, Outcome Assessment
Forms + SF-13 dated 11/5/13.
Subsequent visits would
include SOAP 11/7/13 on top
of the SOAP dated 11/5/13
(latest date is placed on top).
Charts are to be updated with the most current paperwork and placed in the correct order.
Problem Management
ICD #: In the codebook, find the appropriate number that corresponds to the patient’s issues.
Each set of orders / plans applies only to the problem under which it is listed. For instance,
prescribing the use of ultrasound for a neck problem doesn’t authorize the use of ultrasound for a
low back disorder. Once a therapy is discontinued, it cannot be used again on that patient without
new orders by the clinician on the Treatment Plan sheet.
PROGRESS NOTES
(aka “S.O.A.P.” Notes)
Throughout your clinical career, you will be noting in detail the interactions you have with your
patient. The most common and accepted format is called a “SOAP” note. The initials stand for
Subjective, Objective, Assessment, and Plan. A SOAP note is a type of narrative called a
Problem Oriented Medical Record (POMR). The assumption here is that you lead with the
patient’s chief complaint. In general, the orientation of the record is geared to monitoring the
chief complaint, not only in the subjective section but also as a flow seen in all areas.
34 Below you will find both explanations of the chief components of these notes and examples of
the text.
S:
Subjective: This is the story that is told in the patient’s own words. It also can be their response
to a specific question. Minimally this section should include:
• History of the chief complaint or current status of symptoms
• Interim history – how well has the patient done since the last time they were in for care?
• How has the pain changed?
• ADL’s (Activities of Daily Living) – how have these been affected?
• Are they following your recommendations?
• Review of Systems – heart, lungs, fever, cold, cough, weight loss, difficulty breathing,
bladder function
Example: Since the last visit, the patient has experienced a decrease in her low back pain. She
reports that the pain continues to be achy but is more localized to the region of the right PSIS.
She is no longer experiencing the diffuse pain that was extending down her right leg. When
questioned about her exercise program, she admits that she has been doing the last taught set of
Swiss ball exercises only once per day, instead of the twice per day as was recommended. There
has been no change in her health or medical status since her last visit to this office.
O:
Objective: Record here the results of all examinations. The yardstick for objective findings is
those procedures for the purpose of uncovering the nature of a patient’s condition that could be
replicated by another physician of similar training. If a regional or physical examination was
performed, carry over any positive findings from the exam sheet over to the SOAP note. This
allows the SOAP note to be a stand-alone document. Even if the regional examination was lost,
you could still replicate the determining factors from the examination. Record what you found
during inspection: symmetrical, tonicity or swelling. How was palpation performed, motion or
static, and what was uncovered?
If you have completed the regional examinations, consider what high yield screening procedures
you might do to uncover the worse case scenarios in your patient population. For example, vital
signs, active observed range of motion (with or without pain) for the area of manipulation,
mechanical or orthopedic tests for the area to be treated such as Kemp’s, cervical compression,
Schepleman’s, etc. Finish with an explanation of your chiropractic findings, with a brief note
concerning the method used to determine these listings.
Example: Vitals: pulse = 72 bpm, BP = 120/72 right, respiration = 12/m, temperature = 98.6 F
(these results would be written in the margin below the date). The following orthopedic tests
were performed and found to be negative: cervical compression and depression, Kemp’s seated
and Lewin’s tests. Gross ROM in the cervical and thoracic spine was observed and was full and
pain free. Motion palpation detected loss of: right rotation - C3 & L3, extension - L4, left
rotation - C2. The right upper cervical paravertebral musculature was found to be moderately
tender to moderate palpation pressure, markedly taut with a small involuntary twitch noted
during palpation.
35 A:
Assessment: Make a commitment to what you think is going on with the patient. Record here
your differential diagnosis, working diagnosis, and steps you might take to confirm or deny each
item. You can also discuss the patient’s progress by weighing in on factors such as the degree of
subjective improvement that the patient reports and how much your objective findings have
changed. Some doctors use a percentage to describe the amount of improvement realized.
Since chiropractic physicians often deal with various biomechanical problems that do not lend
themselves very well to “sprain/strain,” a more complex language showing the interplay of
factors can be appropriate in this realm. Here are a couple of examples:
Chronic recurrent segmental dysfunction of the right sacral iliac joint secondary to bilateral foot
pronation and an anatomical right lower extremity limb length discrepancy.
In this example you have actually three diagnoses, yet the narrative shows the causal relationship
between these various factors and how they relate to the first diagnosis, the primary concern
causing the patient’s chief complaint.
Thoracic outlet syndrome with radial nerve neuralgia primarily arising from hypertonicity of the
right pectoralis minor. This is with an overlay of myofascial pain referral from the right anterior
scalene muscles and associated segmental dysfunction of the upper thoracic and lower cervical
spine.
In this second example, again you see there is a primary diagnosis, yet the various principle
players that contribute to the malady are also featured. Broken down into components, there are
four different diagnoses running together here in addition to the regions of spinal dysfunction. In
practical terms, on both the problem sheet and your treatment plan, you would list each item
separately.
Note:
After the first visit, when you have established the diagnosis, it is no longer necessary to
repeatedly state the diagnosis. By this point, it should be noted in the treatment plan. Once a
treatment plan has begun, it is far more important that you monitor the patient progress and make
comments concerning your outcomes.
The example immediately below outlines the second component of the assessment section of a
SOAP note. It is here that you summarize the patient's response. Notice that reference is made
to both the subjective and objective aspects of the patient’s status.
Since starting care three weeks ago, the patient has shown a noticeable improvement in both her
symptoms and objective findings, especially the degree of fixation and number of levels involved.
Current treatment appears to be effective and no modification of the treatment plan is required
at this time.
P:
It is helpful to break down the explanation of treatment into what was done today versus what
will be done at the next or future visits. Here is an example of that:
36 Today the patient received supine cervical manipulation for the above noted segments. This was
performed while maintaining the neck in slight flexion and minimizing rotation and lateral
flexion. Soft tissue release was performed using a thumb contact into the right upper trapezius
muscle to patient’s tolerance until a relative degree of muscle relaxation was achieved.
Instruction was given both by example, the patient’s own demonstration and in written format
(see Swiss ball exercise sheet) in a new sitting Swiss ball exercise: one-leg lift. She is to perform
this exercise 20 times (10 per each side) twice per day. If she continues to show good stability on
the ball while performing this and other exercise, we will add the contralateral puppet at the
next visit, in addition to the program outlined in the treatment plan. The next visit is scheduled
for__________.
If you have a high level of detail in your treatment plan, it is acceptable to make reference to the
treatment plan in both the A: and P: sections of the SOAP note for a given day. This reference
would include the actual date of the treatment plan under which you are working. In the A:
section, you still have a responsibility to weigh in on the patient’s status. In other words, in light
of the S: and O: how is the patient proceeding? It is not enough that the patient is feeling better.
Are there also objective changes that support the subjective changes? Remember that S + O = A
-> P. Subjective plus objective adds up to a diagnosis or status report leading to a given mode or
course of treatment.
In addition, for the P: section, specific treatment settings, nutritional supplements and types of
manipulation must be stated. This would also include the teaching of therapeutic exercises,
spelling out frequency, number of repetitions, and the name or description of the actual exercise
taught.
Formulate a detailed and thoughtful treatment plan and you will have the necessary road map for
the best treatment possible for your patient. Use the examples on the next page to guide you.
Referral of a Patient
In the course of management with a given patient, you always have three choices before you:
treat, co-manage or refer. In either co-management or referral, there is a need to let the other
physician know the status of the case. Whether the referral is made internally (within the
National campus) or externally (to a physician outside the campus), a letter of referral is
required. Here are the basic components of a good referral:
• Identify the patient
• Date of the letter of referral
• Brief description of the chief complaint, pertinent PE/laboratory findings and reason for
making the referral
• Very Important – Let the physician know if you are referring the patient for transfer of
care or for co-management of the case!!!
• If co-management, let the other physician know that the patient is still under your care.
• Bring to the other physician’s attention any current issues and lab reports, radiographic
findings, etc. that might help them in their attempts to help the patient
• Print your name with a space above to sign
• Clinician’s name with a space above to sign
37 Filing Laboratory, X-Ray, And Other Reports
Reports from the clinical laboratory, radiology, outside physician’s reports, and consultations
return to the clinic and must be entered in the patient’s file. Do not simply place the reports in the
file. Instead record the results on a progress note and place the results in the appropriate place in
the file. Do not search through the reports without permission of the attending. An attending
clinician will review the report and initial it, and make it available to the intern.
Carefully study the report and review any abnormalities. Enter the results on the progress note.
The results may necessitate a change in the diagnosis or creation of a new problem (such
thoughts should be reflected under the “A” portion). Should the report necessitate further work
or education to the patient, record this under the Plan on the progress note. A new Treatment
Plan may need to be created if the report modifies or creates a new problem for the patient.
Use the example below of an “OAP” note following review of reports:
O: Pt brought to initial visit labs collected on 7/31/09 yielding the following results: Cbc/diff:
MCH <H> @ 32.5 pg (N=27.0-32.0 pg); MPV <L> @ 6.7 FL (N=7.4-10.3 FL). Other values
within reference ranges. CMP: Glucose <H> @ 106 mg/dL (N=65-99 mg/dL). BUN/CREA ratio
<L> @ 7.2 (N=10.0-20.0. ALT <H> @ 64 u/L (N=17-63 u/L). All other values within normal
reference ranges. Lipid Panel: HLD <L> @ 29 mg/dL (N=40-60 mg/dL); triglyceride <H> @
159 mg/dL (N=1-149 mg/dL). GFR within normal reference ranges, all other values within
normal reference ranges. TSH=0.54 UIU/ML (N=0.34-5.60 UIU/mL). Bone Mass Calculation
for DEX scan performed on 1/11/06 yielded the following results: distal BMD T-score= -3.0 and
Distal BMC T score= -2.6.
A: ICD 277.7 Metabolic Syndrome; 733.0 Generalized Osteoporosis 59 YOWF presents to learn
of lab results. Based upon above findings including hyperglycemia and hyperlipidemia, and
previous Dx of HTN (done by her GP) metabolic syndrome fits her current presentation. In
addition, her bone density rating falls within the category for osteoporotic.
P: Pt will follow-up for treatment plan on 5/1/14.
38 Chapter
4
Phlebotomy Procedure
Phlebotomy Procedure
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Show pt that the needle is sealed and open it in front of them
Insert it into needle holder
Put gloves on
Open alcohol swab, Band-Aid, make sure appropriate tubes are available as well as
cotton ball/gauze pad
Place tourniquet on one arm 2 inches above antecubital fossa
Palpate for adequate vein
Release tourniquet
Repeat tourniquet and vein palpation on opposite arm
Once adequate vein in chosen, set supplies on paper towel next to patient (either lying
down or sitting is fine)
Apply tourniquet 2 inches above antecubital fossa
Clean area in a bull’s eye fashion with a folded alcohol prep pad, clean traction hand with
opposite side of alcohol pad (that didn’t clean pt arm)
Make sure bevel is up and cotton ball is ready
Traction above and below area, insert needle at 15-20 degree angle quickly and smoothly
Insert tube with equal and opposite pressure (gold, blue, green, lavender)
Remove tube with equal and opposite pressure (if don’t, the needle will slide farther into
arm)
Repeat if necessary (depending on the number of tubes)
Remove tourniquet when last tube is halfway full. (Make sure tourniquet is released
before pulling needle out because blood will spurt out and hematoma could form.)
Let last tube fill up and remove tube from holder with equal and opposite pressure.
Place cotton ball over the area of the needle. (Don’t press down until needle is out of
arm.)
CAP NEEDLE ON EDGE OF TABLE IMMEDIATELY!!!!!
Have pt hold cotton ball with arm straight and preferably elevated above heart level
Dispose of needle into sharps container
Mix tubes with any additive, if necessary
Apply bandage to arm
Dispose of cotton ball, alcohol pad into gloves. Remove gloves with proper technique.
Dispose of glove package into biohazard.
All other waste without blood on it is regular trash.
Process samples as directed by clinician
39 Considerations
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Never draw from an arm or leg with a shunt or fistula
Avoid drawing from the affected side of a pt with a stroke or radical mastectomy
Never draw above an IV site
With a Pt on anticoagulants (coumadin, heparin) take extra care to stop the bleeding and
apply pressure bandage
Most common site and best site to draw is the Median antecubital (cephalic) vein. This is
the most stable, as there is not much to damage to this area. Lateral vein is next best.
Medial side should be avoided if possible. There are tendons and the brachial artery is in
the area.
Alternate drawing sites, i.e., dorsum of the hand.
To be done only by the clinician or a phlebotomist
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Dorsum of hand, lateral wrist, dorsum of the foot
Ordering Labs From Elmhurst Memorial Hospital – Lombard
Ordering Labs From Quest Diagnostics – Florida
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Take the completed route slip with all labs that you want run for each patient to your
respective Medical Records department. Be sure any lab tests are approved and signed off
by the attending clinician.
The route slip needs to have the patient’s last and first name with correct spelling and the
patient’s birth date listed at the bottom of the route slip.
Lombard Medical Records will enter the labs into the Elmhurst Hospital ordering system.
Florida Medical Records will enter the labs into the Quest Diagnostics ordering system.
After the labs have been completed, the Requisition form and the labels that go on the
specimens will print out.
The intern/doctor will take the labels and put them on the specimen(s). One extra label
will be placed in the patient’s file on the progress note.
Take the requisition and specimen(s) with the printed labels and put them into specimen
bag.
Before placing the specimen(s) into the refrigerator, put the barcode label on the outside
of the bag as you currently do.
Now you may put the specimen(s) into the refrigerator.
Finally, enter patient’s name and the ordering doctor’s name into the big lab book with
the second bar code label as you have been doing.
All labs will print out in Medical Records when they have been completed. Medical
Records will give the lab results to the ordering doctor.
Elmhurst does not automatically pick up orders on Saturdays. YOU MUST CALL TO
REQUEST PICK-UP ON SATURDAYS.
Addendum to EMH Labs • For ABO Blood Group – label the tube with your name and date If the samples are not obtained on that patient visit, for whatever reason, please notify medical
records and the order will be cancelled.
40 ****Student results will be placed into the Student Clinic mailbox or in the box of the attending
physician by medical records.
Lombard Medical Records is open from 7 a.m. to 8 p.m., Monday through Friday, and 7 a.m. to
12 p.m. on Saturday.
Florida Medical Records is open from 8 a.m. to 6 p.m., Monday and Thursday, from 1 p.m. to 6
p.m. on Tuesday, from 8 a.m. to 4:45 p.m. on Wednesday, and from 8 a.m. to 1 p.m. on Friday.
Lombard Clinic Only
All laboratory samples are sent to Elmhurst Memorial Hospital reference labs (unless specifically
advised otherwise by the attending clinician).
Note: An improperly processed sample may be rejected by the lab and result in a redraw of your
patient.
CBC: (Purple top)
After the specimen has been obtained, place the label on
tube. Enter the patient’s name into the clinic laboratory logbook (located in clinic lab), as
indicated in Table I below. Then record the logbook number onto the patient’s requisition.
Affix one label to the CBC tube, one label in the logbook, and one label in the margin of the
progress note for that patient visit. Place the CBC tube into the Ziplock portion of the same bag
and seal it closed. Using a set of the paired EMH tracking labels, place one label on the specimen
bag and the other next to the patient’s label in the logbook. Place the bag and its entire contents
into the refrigerator in the lab.
Urinalysis:
After the patient has collected the sample into the plastic urine transport container, collect the
sample from the patient while wearing gloves. Check to confirm that the cap of the tube is
securely in place and immediately identify the container with the patient’s name. If the sample is
going to EMH labs, take the vacutainer tube and siphon off urine to the tube with preservative.
Place label on specimen. You will complete the logbook, requisition, labeling, and packaging of
the sample using the same procedure as above for the CBC.
Metabolic/chemistry panels (SST, PST tubes):
After collecting the SERUM (gold tubes) specimen from the patient, make sure you have
attached the label to the specimen. The sample must then sit upright in the tube for 15-30
minutes to allow the blood to clot. Once the specimen has solidified, it is then placed in a
BALANCED centrifuge and spun down for 15 minutes. NEVER – leave an unlabeled specimen
to clot or place it into the centrifuge.
While the blood is clotting and spinning, fill out the logbook following the procedures outlined
above for the CBC. The specimen is now packaged as previously described above and placed in
the refrigerator for pick-up.
PST (light green) tubes are handled the same as above, although no clotting time is required (i.e.,
they can be spun down immediately after drawing).
41 Pink tubes are processed the same as CBC tubes. Remember that the requisition must include the
patient SS#; the SS# and your initials must be on the label. The testing will NOT be done
without this info. There are special labels in the lab for this sample.
NOTE: When more than one type of sample is obtained from the same patient (i.e., UA and
CBC), they are all included on the same EMH requisition, the same line of the logbook, and sent
in the same transport bag. If in doubt, check with the EMH reference lab or supervising clinician.
Ordering Labs from Cleveland HeartLab – Lombard
• All supplies are in the ND chief clinician’s office (Currently Dr. Liebich)
• Locate the Cleveland HeartLab Shipping Supplies binder.
• In this binder you will find several supplies you will need, including:
o Requisition form
 Complete the Patient Information section: First and last name, date of
birth and gender are REQUIRED. All other information is helpful. Please
check Yes or No under “Fasting”. “Other patient ID” is the patient’s chart
number.
 Fill in the corresponding box of the lab(s) you wish to run, or manually
write them in under “Other”.
 Have the appropriate clinician sign the requisition form. (The clinician
legally allowed to sign this form will be listed under “Practitioner
information”).
 Fill in the yellow highlighted section on the left side of this form: Draw
date, time and your initials.
 The back of this form also has instructions.
o UPS labels
 Tear off the next label (do not peel off the backing!) and take with you.
o Tube labels
 Obtain the appropriate number of blank tube labels for each tube you will
be using.
 Information needed on each tube includes:
• Patient’s first and last name
• Patient’s date of birth
• If you are using a Sample Tube – the label must also include the
sample type
o NUHS Cleveland HeartLab Test Pricing Form
 Obtain one of these forms
• Do NOT take the last form without making copies
 Highlight each test run on this form, as well as appropriate COST (paying
patient or Emp/Stu cost)
o Cleveland HeartLab Test Menu
 This is in the outside pocket of the binder; please return this form once
you have found the required tubes.
42 
Read over this form to determine which tube is required for each test
• NOTE: A serum tube is the tiger top tube (dark grey/orange)
• NOTE: the red/yellow tiger top is a URINE SPECIMEN tube
 The reverse side of this form describes how each tube is to be processed
and the minimum amount required for each test to be run
• Locate the “Labs Ordered” Folder in your attending clinician’s office.
o Write down the date the test was drawn, the patient’s name and the lab running
the test (i.e. 4/17/2014 Ennsmann, Michelle Cleveland)
• Locate other supplies in the chief clinician’s office:
o Styrofoam box
o UPS Laboratory Shipping Pak mailer
o One biohazard bag
o Applicable tubes (if there is more than one bag of the same type of tubes, please
grab the ones closest to the top or front – these have the most recent expiration
date) or urine cup, sample tube or pipette
• Go to Medical Records to obtain a needle and barrel
• Draw blood/collect urine
• Label tubes
• Prepare blood as required
• Place cold or frozen sample(s) (as indicated per sample directions) in the biohazard bag
• Place completed requisition for each sample in the pouch of the biohazard bag
• Place biohazard bag(s) (with sample(s) and requisition form) in the styrofoam box
• Place a frozen ice pack on top of the samples in the styrofoam box
o You will find several of these in the freezer in the lab
• Check with other clinicians to see if anyone else is performing Cleveland labs the same
day, as numerous samples can be packaged and sent together in the same styrofoam box
and UPS bag
• Place the styrofoam box into the UPS laboratory Shipping Pak
• Place sticky label on outside of UPS laboratory Shipping Pak
• Call UPS at (800) 742-5877 to schedule a “Return Service Labeled” pick-up
o Have the tracking number from the label available
o Provide the closing time of clinic as 6 p.m.
CHECKING OUT PATIENT:
• Fill out information for front desk for proper billing
• Staple NUHS Cleveland HeartLab Test Pricing form (with test(s) highlighted) to the back
of the route slip
• On the front of the route slip, you must write “extra labs” so the front desk will know to
check the back of the slip. It may help to highlight this or underline it.
• On the back of the route slip write “Cleveland Heartlab”
o List test name(s)
o CPT code(s)
o BOTH Emp/Stu cost and patient cost; CIRCLE appropriate cost (Emp/Stu or
patient)
43 SAMPLE REJECTION POLICY
Samples will be rejected for any of the following reasons:
• Sample types were incorrect or samples were received in damaged condition (i.e. tube open or
cracked, sample not shipped at correct temperature).
• Sample tube is not properly labeled with first and last name and date of birth. In addition,
transport tubes must also be labeled with tube type and sample type.
• Samples that are beyond their stability limits.
• Requisition form is incomplete. First and last name, date of birth and gender are required.
• Physician signature is missing.
• Any additional rejection criteria for a test, beyond the above standard criteria, will be listed
on the individual test’s page on our test menu.
Ordering Labs from Genova Diagnostic Labs – Lombard
• All supplies are in the ND chief clinician’s office (Currently Dr. Liebich)
• Locate the “Genova & SpectraCell” binder.
• In this binder you will find information about the tests, and:
o NUHS Genova Diagnostics Lab Pricing form
 Obtain one of these forms
• Do NOT take the last form without making copies
 Highlight each test run on this form, as well as appropriate COST (paying
patient or Emp/Stu cost)
• Obtain the appropriate testing box from the top of the bookshelf. This box should
include:
o Styrofoam box – for frozen or refrigerated samples only
o Instruction form
 Each kit will have a detailed instruction form, please follow this
CLOSELY
 Assure that the box includes all of the indicated supplies (many times
items are missing)
 Each box will have different testing/sampling supplies
• Follow the instruction form carefully to assure the testing will be
done properly
 Every box should have the following supplies:
o Requisition form
 Carefully follow all of the instructions on the form
 Complete the date of sample collection at the top of the form
 Check the appropriate tests that you would like to run
 Assure that the appropriate clinician signs the form (this is the clinician
whose name is printed on the form)
 Billing options:
• Check “Bill Healthcare Practitioner Account”
 Check the appropriate ICD-9 Code(s) or add them in if necessary
 Have the patient complete the purple highlighted Patient Information
section. The labs will NOT be run if this section is incomplete.
 The Medicare Information Section and Payment Information Section do
not need to be completed
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Have the patient read, sign and date the yellow highlighted
Patient/Responsible Party Acknowledgement section. The labs will NOT
be run if this section is incomplete.
o Advance Beneficiary Notice of Noncoverage (ABN)
 Because we cannot bill Medicare for our services, this form is N/A and
can be thrown away
o Prepaid FedEx Bag with Label
Locate the “Labs Ordered” Folder in your attending clinician’s office.
o Write down the date the test was drawn, the patient’s name and the lab running
the test (i.e. 4/17/2014 Ennsmann, Michelle Genova)
Go to medical records to obtain a needle and barrel
Draw blood/collect urine
Label tubes
Prepare blood as required
Place samples(s) in the biohazard bags
The individual test will include instructions on how to properly package the sample for
shipment. This will change depending on if the sample is refrigerated/frozen or stored at
room temperature.
Place completed requisition on top of the test box. Do NOT staple or tape the box.
Place the complete box in the FedEx envelope
Call FedEx at (800) 463-3339 to schedule shipping
o Say “Return a Package”
o Tell the FedEx representative “I am using a billable stamp” and they will walk
you through the process.
o Provide the closing time as 6 p.m.
Fill out information for front desk for proper billing
Staple NUHS Genova Diagnostics Lab Pricing form (with test(s) highlighted) to the back
of the route slip
On the front of the route slip, you must write “extra labs” so the front desk will know to
check the back of the slip. It may help to highlight this or underline it.
On the back of the route slip write “Genova”
o List test name(s)
o CPT code(s)
o BOTH Emp/Stu cost and patient cost and CIRCLE the appropriate one
45 46 Chapter
5
Patient Care
Patient Care
Elective Care
The delivery of health care is both a responsibility and a privilege. At each patient visit,
therapeutic necessity is judged based on the current findings and the history of the patient’s
health. Therapeutic necessity for continuing treatment diminishes as the patient reaches
maximum therapeutic improvement. With that judgment, the patient is usually discharged from
active care for that episode. On occasion, the patient may ask to continue care on an n elective
basis. It is the policy of the University that a patient has the right to seek elective care from any
source including our clinic facilities. Elective care may be administered to any patient who
requests it, provided that the patient is informed that fees for services rendered may not be
reimbursed by a third party payer. The attending clinician or the office manager will undertake
discussion of the specifics of each case. The attending clinician will make a decision on the
appropriateness for elective care. The clinic director may assume this task on behalf of the
attending clinician, if necessary. The business office manager shall discuss all payment options
and inform the clinician and patient if the services will be reimbursed by the third party payer.
The intern is not authorized to discuss the patient’s method of payment or make financial
decisions for the patient’s care.
Walk-In or Emergency Patients
Patients requesting services without an appointment will be given the option of waiting for an
appointment to open or schedule another appointment time. If, in the judgment of the patient, an
emergency situation exists, the front desk will contact the attending physician serving as
Emergency Officer of the Day (EOD). The EOD will determine if a true emergency exists or if
the patient may be made comfortable until the next available appointment time.
It is the policy of the clinic system of National University of Health Sciences to permit
unscheduled patients to supersede the appointments of scheduled care ONLY if a true emergency
exists. A person presenting for treatment without an appointment and determined to not be a
medical emergency will be required to wait to avoid inconvenience of those who have made
previous appointments.
47 Treatment of Minor Patients
In the course of practicing in the clinics, the issue of treatment of minor children will come up.
There are legal requirements that must be met to be sure all parties involved in the encounter are
protected and informed. A child is defined as anyone under the age of 18 who has not been
legally emancipated. Emancipation is declared for children under age 18 by a court of law, which
legally pronounces the child as an adult for purposes of entering contracts, undergoing informed
medical procedures and signing binding contractual agreements. Most of the minor patients who
will be encountered in the NUHS Health System will be living with their parents, guardians or
another adult with the legal status of being able to give consent for treatment. The adult must be
present at the initial visit to give written authorization for examination and treatment. On all
patient information sheets used in the NUHS system, a signature line is present for the adult to
give permission to treat the minor. The signature must be affixed prior to the minor patient
entering the examination room. Failure to obtain the authorization leaves the physician and intern
vulnerable to charges of battery later. Battery is the unauthorized or unwelcome physical
touching of another person. Without authorization by a consenting adult for the minor child, the
act of examining a patient constitutes the legal description of battery.
After the initial visit, and with the clinical decision of the attending physician, the adult giving
consent may not need to be physically present for continuing treatment. The adult must be
informed of the treatment plan and give authorization for carrying out the diagnostic workup and
treatment before the minor will be examined, X-rayed or treated. All risks and benefits must be
outlined to the child, depending on age and ability to comprehend, and the adult giving consent.
If the minor is of an age where they are unable to be left alone or unwilling to be away from the
adult giving consent, that adult must be present. If the minor is able to comprehend and give
historical information, then the attending physician can allow the minor to be seen without the
adult accompanying them.
Although there is no legal requirement to have written informed consent in the patient’s chart, it
is a requirement of the NUHS Health System to have a signed copy of the form obtained and
filed in the chart. A copy of the appropriate Informed Consent Form may be obtained from
your attending physician. Be sure you are familiar with the contents before giving it to the adult
for signing. Witness the signature and have the attending physician countersign the adult’s
signature. This form should be photocopied and one copy given to the adult, the original going
into the patient’s chart. The outside of the chart will be identified by the word “MINOR.”
As with all issues of providing care, the attending physician must be consulted in every issue of
the course of history, physical examination, diagnostic testing, and treatment plans. No minor
patient may be seen in any clinical setting without a signed authorization.
Patient’s Bill of Rights
If the patient lacks decision-making capacity, is legally incompetent, or is a minor, these rights
can be exercised on the patient’s behalf by a designated surrogate or proxy decision-maker.
The patient has the right to considerate and respectful care.
The patient has the right to and is encouraged to obtain from physicians and other direct
caregivers relevant, current and understandable information concerning diagnosis, treatment and
prognosis.
48 Patients have the right to know the identity of physicians, nurses, residents, interns, or other
trainees. The patient also has the right to know the immediate and long term financial
implications of treatment choices, insofar as they are known.
The patient has the right to make decisions about the plan of care prior to and during the course
of treatment and to refuse a recommended treatment or plan of care to the extent permitted by
law and clinic policy and to be informed of the medical consequences of this action. In case of
such refusal, the patient is entitled to other appropriate care and services that the clinic provides
or transfer to another health care provider. The clinic should notify patients of any policy that
might affect patient choice within the institution.
The patient has the right to have an advance directive (such as a living will, health care proxy, or
durable power of attorney for health care) concerning treatment or designating a surrogate
decision-maker with the expectation that the clinic will honor the intent of that directive to the
extent permitted by law.
The patient has the right to every consideration of privacy. Case discussion, consultation,
examination, and treatment should be conducted so as to protect each patient’s privacy.
The patient has the right to expect that all communications and records pertaining to his/her care
will be treated as confidential by the clinic, except in cases such as suspected abuse and public
health hazards when reporting is permitted or required by law. The patient has the right to expect
that the clinic will emphasize the confidentiality of this information when it releases it to any
other parties entitled to review information in those records.
The patient has the right to review the records pertaining to his/her medical care and to have the
information explained or interpreted as necessary, except when restricted by law.
The patient has the right to expect that, within its capacity and policies, the clinic will make
reasonable response to the request of a patient for appropriate and medically indicated care and
services. The clinic must provide evaluation, service, and/or referral as indicated by the urgency
of the case.
The patient has the right to ask and be informed of the existence of business relationships among
the clinic, educational institutions, other health care providers, or payers that may influence the
patient’s treatment and care.
The patient has the right to consent to or decline to participate in proposed research studies or
human experimentation affecting care and treatment or requiring direct patient involvement, and
to have those studies fully explained prior to consent. A patient who declines to participate in
research or experimentation is entitled to the most effective care that the clinic can otherwise
provide.
The patient has the right to expect reasonable continuity of care when appropriate and to be
informed by physicians and other caregivers if available and realistic patient care is no longer
appropriate.
49 The patient has the right to be informed of clinic policies and practices that relate to patient care,
treatment and responsibilities. The patient has the right to be informed of available resources for
resolving disputes, grievances and conflicts, such as ethics committees, patient representatives or
other mechanisms available in the institution. The patient has the right to be informed of the
clinic’s charges for services and available payment methods.
The patient has an obligation to follow the treatment plan agreed to and make every effort to
cooperate in the progression of their treatment to help ensure the desired outcome.
Clinic Fees and Patient Accounts
Patients occasionally have questions regarding their accounts or clinic financial policy. Since
these matters can be construed as verbal contracts, it is important that all such questions be
referred to the attending clinician and business office manager for response. The business office
manager will make financial arrangements with the patient depending on the circumstances of
the case. Do not discuss these matters with the patient yourself.
The intern is responsible for properly recording all services rendered on the route slip. Failure to
indicate services provided to a patient is considered violation of the code of conduct of the
clinics and will result in the intern being charged personally for the services that were not
recorded correctly. In addition, the attending clinician may take further disciplinary action
against the intern.
On the surface, it may seem kind or compassionate to supply treatment (or other services)
without writing it on the route slip or by altering the route slip to obtain a reduced fee for a
patient. However this results in increasing clinic costs that must be absorbed by the University
and by its students. Moreover, should a case be challenged, the financial record is often
compared to the physician’s orders and daily progress notes to test veracity. If these do not agree,
the patient can lose benefits of third party payment. It may further place the clinic in violation of
federally controlled programs and lead to fines and sanctions.
Billing Categories
Charity Treatment
All discounts, charity case decision requests, etc. may be initiated only by the attending
physician in close conference with the business office manager. The business office manager
may make the financial decisions in concert with the Dean of Clinics. No clinician or intern may
make the offer of charity treatment without clearing the matter through the business office. If it is
discovered that charity treatment has been extended without authorization, the intern and/or
clinician will be financially responsible for all charges. Extenuating circumstances can be
explained by a letter co-signed by the supervising clinician and clinic director and should be
forwarded to the business office manager of the clinics who will consult with the Dean of
Clinics.
Treatment of Interns
If an intern wishes to be treated at the clinic, an Intern Treatment Only route slip must be
obtained and all services must be appropriately recorded on that slip. All patient record protocols
must also be adhered to. Interns are reminded that all procedures counted towards graduation
50 requirements must be verifiable in the medical records. Intern treatments must not be recorded
on regular patient route slips (yellow routing slip). All fees that normally apply to students, also
apply to the intern being treated (i.e., lab fees, X-rays, free adjustments, and therapy).
Procedure for Intern Treatment
• Notify your clinician that you wish to treat an intern. Obtain the clinician’s permission
and get a yellow routing slip.
• Complete the section of the slip indicating the intern’s file number and name, your
clinician’s name, and the date.
• Check the intern’s file out of Medical Records.
• Provide the services ordered by the clinician.
• Complete the route slip, recording your intern number next to the services you provided
and listing the proper diagnosis(es) for the visit.
• Obtain your clinician’s signature on the completed route slip.
• Take the completed route slip to the cashier.
• Complete your charting of the visit in the medical record, then have your clinician sign
the progress note and return the file to Medical Records.
Any intern credits recorded on the weekly Intern Tally Sheet that DO NOT have corresponding
entries in the clinic computer system or medical record will be denied and the disciplinary code
penalties for claiming false credit on clinical services will apply.
Diagnostic Imaging Guidelines
General Guidelines
•
•
•
•
•
Food is not permitted in the department. Drinks are allowed only if in a spill-proof
container.
X-ray or MRI files must be signed out before the can be removed from the department.
X-ray or MRI files must be signed back into the department.
Patients must wear shoes or socks while in Radiology.
Professional behavior is expected at all times while in Radiology.
X-ray Positioning and Factoring (P&F) and Report Writing Procedures
•
•
You must complete 30 P&Fs prior to graduation. Your best opportunity to meet this
requirement occurs during the course of your internship while radiographing the patients
that you are treating. You will receive one credit per correctly performed radiograph (i.e.
seven credits possible from a Davis series).
Be prepared to perform the studies yourself (no “cheat sheets” allowed in radiography
suite) or you will receive no credit. Five credits are awarded to all interns at the start of
their Eighth Trimester for the successful completion of the P&F class in Seventh
Trimester.
51 •
Procedures for earning P&F credits and for performing radiographic studies on patients
vary according to the clinic at which you are stationed. Please consult the technologist or
your supervising clinician for details.
NUHS Clinic System Diagnostic Imaging Procedures – Illinois
•
•
•
•
•
•
Record the patient’s name, date, series, and the doctor’s name in the X-ray log book.
Type the patient information on the ID/flash card. (Aurora only)
Make sure that the patient is gowned (if appropriate) and that jewelry, dentures or
clothing (ex. bra, belts, pants with rivets, buttons, or zippers, or any body piercings, etc.)
that may generate artifacts are removed.
Be prepared to position the patient for the study and calculate the factors to be used.
Have the clinician or resident check your technique and make the exposure. Interns are
not permitted to “push the button” and make exposures.
Make sure that your name, the views you performed, and either a clinician or a resident
signature is recorded on the Radiology Positioning Credit forms located in the radiology
suite. (Lombard clinic)
NUHS Clinic System Diagnostic Imaging Procedure – Florida
•
•
•
•
Make sure that the patient is gowned (if appropriate) and that jewelry, dentures or
clothing (ex. bra, belts, pants with rivets, buttons, or zippers, or any body piercings, etc.)
that may generate artifacts are removed.
Be prepared to position the patient for the study and calculate the factors to be used.
Interns are required to bring their own Supertech calculator and laterality markers.
Have the clinician or resident check your technique and make the exposure. Interns are
not permitted to “push the button” and make exposures.
Make sure that your name, the views you performed, and either a clinician or a resident
signature is recorded on the Radiology Positioning Credit forms located in the radiology
suite. (Lombard clinic) This must be turned in the same day as the radiology procedure.
Indications for X-ray Examination
It is understood that X-ray studies should be performed only when it is believed that they will
significantly contribute to case management and diagnosis. It is, however, ultimately left to the
discretion of the clinician when to proceed with X-ray evaluation. As an intern involved in the
management of any particular case, please be prepared to discuss the rationale for ordering
radiographs with radiology personnel. The decision to take radiographs should be based upon
information gathered from the case history, physical examination, and lab data (when available).
Below is a table taken from Essentials of Skeletal Radiology, by Yochum and Rowe, p.7, Table
7.2 that illustrates the guidelines for obtaining skeletal radiographs:
52 Table 4.1
Guidelines for Obtaining Skeletal Radiographs
Probable Indicators
Recent trauma
Neurologic deficit
Inflammatory arthritis
History or suspected malignancy
Fever of unknown origin (>100 °F)
Deformity (scoliosis, congenital)
Recent surgery
Failure to respond to therapy
Possible Indicators
>50 years of age
Drug or alcohol abuse
Corticosteroid use
Unavailability of alternate imaging
Unavailable/lost technically inadequate studies
Constitutional/systemic disease
How to Order Radiographic Studies at NUHS Clinics
•
Call Radiology (ext. 6832) before bringing your patient back for X-rays. This helps
prevent unnecessary waiting in the department. (Lombard clinic only)
•
A requisition form must be completed legibly and signed by the referring physician. Xrays will not be taken without a completed and signed requisition form.
•
Make sure that your female patients are within the first 10 days of their menstrual cycle
(10-day rule) and have them sign and date a pregnancy release form.
•
Inform the clinician/resident that your patient is ready and what radiographs are to be
obtained.
•
Please remain with your patient while they are in X-ray. It is important that your patient
be attended while receiving procedures.
•
It is the intern’s responsibility to present the patient’s route slip to the clinician/resident
for completion. If the service rendered is not on the route slip, the patient cannot be
charged. Failure to complete the route slip is a common error that often results in
misunderstanding, inconvenience, accounting dilemmas, embarrassment, loss of revenue,
and loss of intern credit. The intern will be responsible for paying for any procedure that
they performed but did not charge the patient for.
•
Interns must be prepared to correctly position and calculate technical factors for the
studies being performed.
•
Once the study has been reviewed and approved by a clinician, resident or radiologist,
interns are expected to escort patients from radiology after successful completion of the
procedure.
53 Radiological Studies (By Region)
**Some studies will be performed recumbent unless standing radiographs are specifically
ordered and factors do not exceed tube limits.
Cervical Spine
Limited Medicare series: on patients over age 65, APOM, APLC and Lateral
Limited series: APOM, APLC, Lateral
5 view series: APOM, APLC, Lateral, Obliques
Davis series: 5 views plus flexion and extension views
Special views: as needed by radiologist: pillar arch views. Oblique odontoid views,
swimmers lateral view
Thoracic Spine
Limited Medicare series: AP, Lateral & PA Chest
Routine series: AP, Lateral & PA Chest
Special views: as needed by radiologist
Ribs
Routine series: PA chest & Oblique
Special views: as needed by radiologist: Swimmers lateral
Chest
Routine series: PA chest and Lateral Chest
Special views: as needed by radiologist: Apical lordotic, Full Chest Lordotic, obliques
Lumbar Spine:
Medicare series: AP, Lateral, AP angulated lumbosacral spot
Routine: AP, Lateral, AP angulated lumbosacral spot
Full series: AP, Lateral, AP angulated spot, Obliques
Special views: as needed by radiologist: AP angulated spot, Lateral Spot Projection,
Angulated Oblique, Flexion & Extension Lateral
Full Spine
14x17 Bucky AP & Lateral Sectional Views (Lumbar, Thoracic & Cervical)
Pelvis
Routine series: AP Pelvis
Hip
Routine series: AP Pelvis, AP Spot, Frog Lateral of involved hip
Coccyx
Routine series: AP & Lateral
54 Knee
Routine series: AP, Lateral. Tunnel, Tangential Patella
Patients over 40: Replace AP with bilateral AP weight-bearing study
Special views: as needed by radiologist
Ankle
Routine series: AP Mortise, Lateral & Medial Oblique
Special views: as needed by the radiologist: Eversion & Inversion Stress
Foot
Routine series: Dorsoplantar, Lateral & Medial Oblique
Special views: as needed by the radiologist
Tibia/Fibula
Routine series: AP & Lateral
Special views: as needed by the radiologist
Femur
Routine series: AP & Lateral
Special views: as needed by the radiologist
Shoulder
Routine series: Internal rotation, External rotation & Baby Arm
Special views: as needed by the radiologist: Transthoracic, Scapular “Y”
Acromioclavicular Joints
routine series: AP weighted and AP non-weighted
Elbow
Routine series: AP, Lateral, Internal Oblique & Jones
Special views: as needed by the radiologist: External Oblique
Wrist
Routine series: PA, Medial Oblique, Lateral & Ulnar Deviation
Special views: as needed by the radiologist
Hand
Routine series: Dorsopalmar, Medial Oblique & Lateral
Special views: as needed by the radiologist
Fingers
Routine series: PA Hand, Medial Oblique and Lateral of involved finger
55 Radius/Ulna
Routine series: AP & Lateral
Special views: as needed by the radiologist
Humerus
Routine series: AP & Lateral
Special views: as needed by the radiologist
Abdomen
Routine series: Supine KUB
Special views: as needed by the radiologist: PA & lateral (upright and/or recumbent)
Functional Radiography
Standing Lateral Bending
The standing lateral bending examination of the lumbar spine is performed with the patient
initially in the AP lumbar position. The patient bends as far as possible with the ipsilateral hand
sliding along the lateral aspect of the thigh and hip. Effort must be made to discourage rotation at
the pelvis and shoulders. There are three exposures made: Neutral, Left Lateral Bending and
Right Lateral Bending.
Lumbar Standing Flexion and Extension
The patient stands with their legs straight and shoulder width apart. For flexion, the patient bends
forward at the waist as far as possible with care taken to avoid rotation. For extension, the patient
bends backward as far as possible. There are three exposures made: Neutral, Flexion and
Extension.
Special Intern Study Program (Radiology)
Special study opportunities are available to interested interns in the Radiology Department
during the Tenth Trimester. The special study rotation will include reading radiographs with the
residents and radiologists, assisting in special procedures, and preparing for state board
examinations by utilizing the ACR pathology file and audiovisual material in the department.
Interns are expected to stay in the department at all times during this special rotation.
Sessions run daily for two weeks from 8:00 a.m. to 2:00 p.m. If the number of applicants
outnumbers the number of slots available, the department will select participants based upon
performance during the regular rotation and classroom setting.
Requirements are as follows:
• Completion of all graduation requirements at your main clinic
• A completed application with the signatures from the Radiology department head, clinic
director and Dean of Clinics. (See special study request form at the end of this manual.)
This form should be submitted at least two weeks before the desired session is to begin. On the
application, please select three choices for dates of attendance
56 Chapter
6
Outcome Disability Questionnaires
A variety of questionnaires are utilized by the physician to diagnose a patient’s area and level of
disability.
Back Pain Questionnaire
Patients are asked to indicate how back pain affects their daily life in such areas as lifting,
walking, sleeping, social life, traveling, employment, etc.
Diet Diary
On this chart, patients record the type of food, quantity and method of preparation for a four-day
period.
Disabilities of the Arm, Shoulder and Hand (DASH)
Patients are asked to describe their ability to perform certain activities utilizing the arm, shoulder
and hand.
Headache Diary
Patients are asked to record headache pain including timing, warning signs, type and intensity of
pain, etc.
Lower Extremity Functional Scale
Patients are asked to rate their inability to perform specific activities due to lower limb problems
from extreme difficulty to no difficulty.
Modified Zung Depression Index
Patients are asked to respond to a variety of positive and negatively worded statements ranging
from “rarely or none” to “most of the time.”
Neck Disability Index
Patients are asked to indicate the statements that most closely describe their inability to perform
specific activities due to neck pain.
Oswestry Low Back Pain Disability Questionnaire
Patients are asked to rate their ability to perform a variety of activities on a 0-5 scale.
57 Pain Chart
On drawings of the front and back of the human body, patients are asked to use designated
symbols to indicate their type and area of pain from numbness to stabbing.
Patient Specific Functional and Pain Scales (PSFS)
On this follow-up form, patients are asked to indicate whether or not they are still having
difficulty with activities they indicated in a previous visit.
TMD Disability Index
Patients are asked to rate their ability to perform a variety of activities that would be indicative of
temporomandibular disorders (TMD).
TMJ/TMD Outcome Assessment Form
Patients are asked to check a series of symptoms indicative of temporomandibular joint disorder
(TMJ) / temporomandibular disorders (TMD).
Visual Analog Scale
On a horizontal line ranging from “no pain” to “worst pain imaginable,” patients are asked to
mark the point that they feel represents their perception of their current state for various regions
of the body.
58 Chapter
7
Clinic Disciplinary Protocols
During the internship phase of the curriculum, clinicians assume the primary role of
supervisor/instructor to the interns assigned to them. Clinicians are faculty members tasked with
the responsibility of evaluating an intern’s skill at distilling all the information acquired from
their academic coursework into useful clinical knowledge. At the same time, clinicians are also
evaluating an intern’s development of non-cognitive skills, character traits and personal
attributes that are just as important as clinical knowledge. An intern’s trainee status dictates
restriction of full practice privileges, but it does not diminish their obligation to cultivate and
demonstrate the habits and mannerisms of professional conduct far in advance of graduation.
These skills are revealed over time through acts of compassion, trustworthiness, sound judgment,
personal accountability, respect for others, and the capacity to exceed mere compliance with
rules or avoiding prohibited behavior.
Monitoring the progress of each intern’s personal development relies upon a carefully fostered,
mentoring relationship between each intern and their attending clinician. This important
relationship involves more subtle, interactive assessment of a student than the limited revelations
of a multiple-choice exam. Ultimately, it provides the most effective learning platform for
interns to strengthen any areas of weakness and refine their competence, personal integrity, selfdiscipline, and confidence prior to graduation, and afterward, to assuming their role as a
healthcare professional.
There are numerous expectations that must be met and competencies that must be mastered
during a clinical internship. Intern training within the NUHS clinic system begins with a week
of orientation and the issuance of the NUHS Clinic Intern Manual. The NUHS Clinic Intern
Manual is used to orient interns to the NUHS clinic system of rules, regulations and office
protocols. Copies of the clinic system business forms are reviewed, and several state and
federal laws that are enforced within the clinic system are explained. At the conclusion of
orientation, every intern submits a signed and dated form acknowledging having read and
understood the contents of their NUHS Clinic Intern Manual. Interns are also informed that
failure to comply with the NUHS clinic system rules or procedures described within the NUHS
Clinic Intern Manual may have automatic penalties ordered by their supervising clinician
when specific infractions (listed below) occur. These measures are used to help an intern
correct a deficiency in competence or rectify a conduct infraction without interrupting:
1. The quality or continuity of patient care; and/or
2. The timely completion of internship; and/or
3. The degree completion credit an intern may have earned toward graduation requirements.
59 Automatic Penalties For Clinic Infractions
Clinicians may impose an automatic penalty upon an intern who has committed any of the
infractions listed below. Repeat occurrences of the same infraction or commission of other
infractions on a different occasion may be managed by increasing the severity (quantity) of the
penalty after consulting with the Chair of Clinical Practice.
If, however, an intern fails to complete a penalty, decides to dispute an assigned penalty, or the
supervising clinician and the Chair of Clinical Practice deem the nature or severity of an intern’s
infractions to merit additional administrative review or referral for disciplinary sanctions that
may result in suspension or expulsion of the intern, then the matter shall be referred to the Dean
of Clinics. The infractions and penalties are listed below:
•
Infraction: Unauthorized performance of clinical service on any person, withholding clinical
information on a patient’s condition, or withholding services that were ordered by the
clinician.
Penalty: Intern will not be allowed to count that patient toward their new patient/college
service requirement. All treatments carried out during the course of the patient visit will be
disallowed. Intern will be suspended from patient care for three days and must complete an
appropriately referenced 10-page paper on a topic chosen by the clinician or the Chair of
Clinical Practice.
•
Infraction: Unauthorized use or possession of clinic equipment or facilities, including being
present in clinic after their attending clinician has left the building.
Penalty: Suspension from patient care for two weeks. Unauthorized use of copy machine
will result in confiscation of copy materials and/or charge for copies and use of equipment.
Clinic records, equipment, furniture, office supplies and patient files are the property of
NUHS. Removal, attempted removal, and/or duplication of clinic records (without
authorization), through the use of copy machines or any electronic device (e.g., camera,
handheld scanner, smart phone, laptop/tablet with camera, flash drive) will result in
suspension for 2 weeks and may be referred to law enforcement authorities as property theft.
•
Infraction: Unauthorized absence from clinic, including failure to notify clinician in a timely
fashion of inability to be present at clinic shift due to illness, emergency or habitual tardiness.
Interns must notify their clinician within 20 minutes of the start of their regular shift or
rotation if they have an illness or emergency.
Penalty: May range from making up one or more days per absence to repeating the entire
trimester.
•
Infraction: Unsatisfactory dress/appearance or poor personal hygiene, as indicated by
attending clinician.
Penalty: Exclusion from clinic until the situation is rectified. Absence must be made up and
additional days may be added at the clinician’s discretion.
•
Infraction: Failure to complete charting of patient visit, including having the record signed
by attending clinician at the end of the visit, and failure to return the record to Medical
Records by the end of the shift.
Penalty: The intern(s) involved in the patient care for the date in question will not receive
credit for the visit or services rendered. An additional two duty shifts will be made up.
60 •
Infraction: Failure to record/carry out services ordered by the attending clinician.
Penalty: Exclusion from patient care for two days and loss of credit for the patient service on
the date in question. The intern will also be personally responsible for all services
rendered but not recorded on the route slip.
•
Infraction: False claim for credit on clinical services or other internship (graduation)
requirements.
Penalty: Deduction of the falsified credit plus an additional 10 University Service Credits
and an additional 40 non-student CMTs to be completed prior to graduation.
•
Infraction: Failure to have a professional attitude toward colleagues, other professionals,
patients, clients, support staff, and professionals from other programs. If, for any reason, an
intern acts with deliberate disregard of the authority of the attending clinician, the intern
may be referred, by the Dean of Clinics, to the Committee on Discipline for a formal hearing
where the intern’s misconduct shall be subject to the full range of disciplinary sanctions cited
within the NUHS Student Code of Conduct.
Penalty: Ranges from loss of patient credits to suspension from clinic duties. Depending on
the nature, severity and potential for the misconduct to adversely affecting the interests or
reputation of the clinic or University. Penalty may range from loss of patient credits to
suspension from clinic duties for a specified period of time by the clinician.
Lombard Only
• Infraction: Failure to attend the mandatory trip to Standard Process Inc.
Penalty: Two-for-one make-up shifts and attendance on the next trip.
NOTE: Any make-up shifts ordered as a result of an infraction will be served at a time and place
approved in advance by the clinic director. Under no circumstances shall such time be served
prior to the beginning of “Pink Slip Week.” Pink slips will be withheld and diplomas will not be
awarded until all necessary time has been completed.
Hearing Procedures
If an intern fails to complete a penalty, decides to dispute an assigned penalty, or the supervising
clinician and the Chair of Clinical Practice deem the nature or severity of an intern’s infractions
to merit additional administrative review or referral for disciplinary sanctions that may result in
suspension or expulsion of the intern, then the matter shall be referred to the Dean of Clinics.
The Dean of Clinics shall confer with the Dean of Students to discern which hearing procedure is
best suited to address the issues resulting from the infractions while safeguarding the interests of
the student and the institution. (Under the aegis of the University President, the Dean of Students
functions as the primary university official responsible for the administration of the NUHS
Student Code of Conduct. The Dean is also the arbiter of procedural interpretations or disputes
related to intern conduct and discipline arising from alleged violations of the NUHS Clinic Intern
Manual.) The hearing procedures used to conduct a formal or informal hearing are derived from
the NUHS Student Code of Conduct (full text version available online at:
http://www.nuhs.edu/media/175591/code_of_conduct.pdf).
61 The University system that is used to manage student conduct and discipline is not analogous to,
is not equivalent to, and does not conform to, the criminal or civil law process. The NUHS
Student Code of Conduct is designed, in part, to determine individual or group responsibility, or
lack thereof, for violations of the NUHS Student Code of Conduct or Clinic Intern Manual only –
not guilt or innocence under federal, state, or municipal laws.
Disciplinary hearings shall be carried out in a manner that ensures that fairness is observed and
shall not be restricted by the formal rules of evidence governing criminal and civil proceedings
nor shall minor deviations from the described hearing procedures necessarily invalidate a
disciplinary decision, unless significant prejudice to a student or the University may result.
Informal Hearing
If the Dean of Clinics elects to manage the matter through the use of an informal hearing, the
intern shall be notified in writing of the issue(s) that prompted the referral and a meeting shall be
scheduled for the intern to meet with the Dean. The date of the meeting shall allow the intern a
reasonable time to prepare a response/explanation for committing the infraction(s). The Dean
may tape record this meeting and admit record(s), witness(es), written statement(s) or exhibit(s)
deemed contributory or important to a fair hearing. An advisor or an attorney shall not assist the
intern. After the meeting, the Dean of Clinics shall write a brief summary report that will include
a final decision (reduce or uphold the penalties assigned by the attending clinician and/or Chair
of Clinical Practice and take no further action, or impose an additional disciplinary sanction).
The report shall be the property of the University. This report shall be on file with the Dean of
Clinics. The decision of the Dean of Clinics shall be final pending an appeal based upon the
criteria set forth in the Appeal Process section of the NUHS Student Code of Conduct. Formal
rules of process, procedure, and/or technical rules of evidence, such as are applied in criminal or
civil court, are not used in student disciplinary proceedings.
Any change in status of the intern with the University resulting from the Dean’s decision shall be
transmitted in writing to the VP for Academic Services, the VP for Administrative Services, the
Dean of Students, the Chair of Clinical Practice, the Attending Clinician, the Director of the
Business Office, the Director of Financial Aid, and the Registrar.
Formal Hearing
If the Dean of Clinics elects to manage the matter through the use of a formal hearing, the Dean
of Students shall notify the intern in writing and a copy of this notification shall also be
forwarded to the Committee on Discipline. A formal hearing shall follow the guidelines set forth
in the Hearing Procedures section of the NUHS Student Code of Conduct.
Any change in status of the intern with the University resulting from the Committee’s decision
shall be transmitted in writing to the VP for Academic Services, the VP for Administrative
Services, the Dean of Clinics, the Dean of Students, the Chair of Clinical Practice, the Attending
Clinician, the Director of the Business Office, the Director of Financial Aid, and the Registrar.
62 Chapter
8
Incident/Accident Report Procedure
The following procedure must be followed whenever any accident or incident takes place in
which one of our patients, students, interns, employees, or visitors is injured in any manner and
from any cause while in the facilities of the National University of Health Sciences.
1. Attend to the immediate needs of the person as competently and as quickly as possible.
Call for help. Make sure that the person is protected from further injury and make the site
as safe as possible. If the injury is of a nature that cannot be handled by the Whole Health
Center, arrangements must be made for immediate emergency medical transportation to
another facility that is capable of handling trauma. No employee, student, intern, or
visitor shall transport an injured person in their private vehicles.
2. Report the accident or incident immediately to the Emergency Officer of the Day (EOD).
The EOD is the clinical faculty member assigned for the duration of the shift. This is a
rotating position. The EOD will generate the initial Accident/Incident Report. This form
is filled out in detail. See Appendix L.
3. If the Accident/Incident Report refers to a patient, a copy must be put in the patient’s
medical records file.
4. The Attending Clinician or Staff Member completing the Accident/Incident Report will
forward the original to their Immediate Supervisor (Chair for Clinical Practice or Clinics
Business Services Coordinator). The Immediate Supervisor completes a Supervisor’s
Report (See Appendix M) for the accident/incident. Both reports are forwarded to the
Dean of Clinics. The Dean of Clinic’s Administrative Assistant will keep a copy of both
completed forms, prior to sending the originals to Human Resources.
5. The Dean of Clinics will report the incident to the Clinic Risk Management Committee.
6. The Dean of Clinics will advise the Vice President for Academic Services of the incident
and any additional information that has been found on further investigation.
FLORIDA ONLY:
7. Special note for incidents/accidents that occur at the Health Education Center
(HEC) of SPC, in addition to above steps:
a. Contact SPC security, 727-341-3654
b. Contact the SPC Provost’s Office, 727-341-3664
c. Contact the Dean of the College of Professional Studies’ office, 727-394-6058
63 64 Chapter
9
OSHA Training and Compliance
The University has an OSHA training program for the academic clinical faculty and the clinical
faculty. The OSHA compliance officer is located in the clinical offices. Basic information is
provided below. For information regarding the official OSHA manual and training material call
extension 6851.
Universal Precautions and Infection Control
Barrier Precautions
Barrier precautions, including gloves, should be taken to prevent contact of skin and mucous
membranes with the patient’s blood or other body fluids.
During venipuncture and emergency procedures, gowns, aprons and other body coverings should
be worn. This covering should be able to be removed and prevent penetration of body fluids if
contaminated. Gloves should be worn whenever doing venipuncture, examinations where body
fluids may be contacted, or processing specimens for laboratory analysis.
Precautions While Handling Sharp Devices, e.g. Needles
All disposable needles, scalpels or sharp devices from invasive procedures (acupuncture,
venipuncture) must immediately be placed in puncture-proof containers for disposal. No sharp
device shall be left on a tabletop, examination table, or countertop.
UNDER NO CIRCUMSTANCES SHOULD A SYRINGE OR NEEDLE BE RECAPPED
OR LEFT UNATTENDED. PLEASE PROPERLY DISCARD OF ALL NEEDLES IN
THE BIOHAZARD BINS.
For the University’s purpose, all needles are disposed of properly and not autoclaved for reusable
purposes.
First Aid After Needle Stick
If a needle stick or injury occurs in which the skin is scratched or pierced with a potentially
infected device, the following procedures must be followed:
• Immediate attention to the wound for decontamination must be carried out. This includes
allowing bleeding if it is bleeding at the time.
65 •
•
•
•
•
Wash with an antiseptic soap or other germicidal agent approved for wound management.
Report incident to Infection Control Committee with the Report of Injury form available
from clinical faculty or Dean of Clinics.
Draw blood from individual whose body fluid is in question for possible HIV/HepB
testing (with consent).
Offer blood testing to injured party (with consent).
Advise to watch for signs of infection and care of wound.
Additional Infection Control Measures
Hands and Other Skin Surfaces
•
Hands must be thoroughly washed before and after examining the patient and doing
procedures such as acupuncture, venipuncture, gynecological and proctological
examinations.
•
Hands and other skin surfaces that have been accidentally contaminated with blood and
other body fluids must be scrubbed immediately with germicidal soap.
•
Hands must be washed after removing masks, gloves or other barrier devices.
Mouth-to-Mouth Resuscitations (CPR)
•
A barrier must be used to prevent transmission of infection by saliva or blood in the
mouth and/or nose.
•
Anyone with an active, draining skin or mucous membrane lesion must not handle the
patients or equipment that will come in contact with the patient.
INFECTION CONTROL PROCEDURES
Prevention of Transmission of Infectious Disease
The following section addresses the prevention of transmission of bloodborne pathogens, and is
adapted from the NUHS Exposure Control Plan (5/92). It is in conformance with, and
supplements, the CDC guidelines (“Update: Universal Precautions for Prevention of
Transmission of Human immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Other
Bloodbome Pathogens in Health Care Settings,” June 24, 1988)
Definitions (adapted from OSHA):
Blood means human blood, human blood components, and products made from human
blood.
66 Bloodborne Pathogens means pathogenic microorganisms that are present in human blood
and can cause disease in human. These pathogens include, but are not limited to, hepatitis B
virus (HBV) and human immunodeficiency virus (HIV).
Contaminated means the presence or the reasonably anticipated presence of blood or other
potentially infectious materials on an item or surface.
Contaminated Laundry means laundry, which has been soiled with blood or other
potentially infectious materials or may contain sharps.
Contaminated Sharps means any contaminated object that can penetrate the skin including
but not limited to needles, scalpels, broken glass, and broken capillary tubes.
Hand Washing Facilities means a facility providing an adequate supply of running potable
water, soap, and single use towels, or hot air drying machines.
HBV means hepatitis B virus.
HIV means human immunodeficiency virus.
Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or
parenteral contact with blood or other potentially infectious materials that may result from
duties.
Other Potentially Infectious Materials means:
1. The following human body fluids: semen, vaginal secretions, synovial fluid, amniotic
fluid, and any body fluids in situations where it is difficult or impossible to differentiate
between body fluid;
2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
3. HIV-containing cells or tissue cultures, organ cultures, and HIV or HBV-containing
culture medium or other tissues from experimental animals infected with HIV or HBV.
Parenteral means piercing mucous membranes or the skin barrier through such events as
needle sticks, human bites, cuts, and abrasions.
Personal Protective Equipment is specialized clothing or equipment worn by a student or
employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts,
or blouses) not intended to function as protection against a hazard are not considered to be
personal protective equipment.
Source Individual means any individual, living or dead, whose blood or other potentially
infectious materials may be a source of occupational exposure to the intern. Examples
include, but are not limited to: hospital and clinic patients; clients in institutions for the
developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities;
67 residents of hospices and nursing homes; human remains; and individuals who donate to sell
blood or blood components.
Sterilize means to use physical or chemical procedures to destroy all microbial life including
highly resistant bacterial endospores.
Universal Precautions is an approach to infection control. According to the concept of
Universal Precautions, all human blood and certain human body fluids are treated as if
known to be infectious for HIV, HBV and other bloodborne pathogens.
Universal precautions have been recommended by the CDC to protect health care workers
from bloodborne diseases and should be consistently used for all patients. The update
specifies the body fluids that universal precautions apply to:
• blood
• any body fluid containing visible blood
• semen
• vaginal secretions
• tissues
Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and
vomitus unless they contain visible blood. Some special settings may require protective
barriers such as health care workers wearing gloves in breast milk banks or dental workers
wearing gloves, masks and protective eyewear during dental procedures.
As stated by the CDC, “Blood is the single most important source of HIV, HBV and other
bloodborne pathogens in the occupational setting. Infection control efforts for HIV, HBV and
other bloodborne pathogens must focus on preventing exposures to blood as well as delivery
of HBV immunization.”
Universal precautions are meant to complement routine infection control practices in health
care facilities, such as hand washing and using protective barriers in other situations of gross
microbial contamination. The judgment of the health care worker must be depended upon
for specific clinical situations.
The university formally adopts the use of Universal Precautions, and all human blood and
certain human body fluids shall be treated as if known to be infectious for HIV, HBV and
other bloodborne pathogens.
Proper Needle Use and Disposal
Self-sheathing needles will be used whenever possible.
Contaminated needles are to be immediately disposed of in a sharps device located in the room.
Recapping of needles is not permitted. In the unforeseen event that a needle has been used but no
sharps container is available or operational in the room, a one-handed scoop method of recapping
68 (the cap lays on a flat surface) shall be used; such occurrences are to be reported to the intern’s
supervisor verbally and by a written incident report form.
Needles are to be removed from vacutainer holders only by the device on the lid of the sharps
container; removal of needles by hand is not permitted.
Containers
Containers used for disposal of contaminated sharps will be closable, puncture-resistant, and leak
proof on the sides and bottom. The containers will be red in color or labeled with the biohazard
symbol. Cardboard sharps containers are not permitted.
Sharps containers will be located in the rooms where sharps are used. It is not acceptable to have
to transport a sharp into another room for disposal. In the clinics, sharps containers will be
located in the following areas: patient examination rooms, clinical laboratory, electrodiagnosis
room, and acupuncture rooms. Additionally, each portable phlebotomy tray shall have a sharps
container.
Sharps containers shall be monitored on a bi-weekly basis and changed as needed to prevent
overfilling. Small (hand-sized) containers shall be disposed of when no more than half (50%)
full. Large (pint and larger) containers shall be disposed of when no more than three-quarters
(75%) full. Monitoring of the containers shall be done by the clinic director/supervisor or their
designee; such person shall be named at the beginning of each academic trimester, as well as the
alternate in case of vacation. A log of inspection and replacement of sharps containers shall be
kept. Any intern who discovers a sharps container, which is overfilled, shall report such to the
clinic director/supervisor. Sharps containers in patient rooms shall be kept out of the reach of
small children.
Sharps containers shall be transported in an upright position and provided with support to
prevent tipping during transport.
Management of Broken Glassware and Spills
Only mechanical means (tongs, brush and dust pan) shall be used to clean up broken glassware.
The use of bare or gloved hands to directly pick up broken glass is not permitted. Tools used in
cleanup of contaminated broken glass should be disinfected after use.
Broken glassware shall be placed in sharps containers.
Spills of blood and potentially contaminated fluids shall be wiped up with absorbable material,
which shall then be placed into biohazard containers. The spill area shall be decontaminated with
a tuberculocidal germicidal disinfectant.
Hand Washing
Hand washing facilities are also available to the interns who incur exposure to blood or other
potentially infectious materials. OSHA requires that these facilities be readily accessible after
69 incurring exposure. At this facility, hand washing facilities are located in patient examination
and treatment rooms, laboratories, and restrooms.
Interns shall wash hands with soap and water when gloves are removed and as soon as possible
after any contact with blood or other potentially infectious materials.
At locations where hand washing facilities are not reasonably accessible (for example, offcampus health screening activities), antiseptic towelettes or antiseptic hand cleaners may be used
until the hands can be washed with soap and running water.
If interns incur exposure to their skin or mucous membranes, then those areas shall be washed or
flushed with water as soon as feasible following contact.
Eating and Personal Care
Interns may not eat, drink, apply cosmetics or lip balm, or handle contact lenses in contaminated
work areas.
Food and beverages may not be kept in refrigerators, cabinets, shelves, countertops, or other
areas with blood and other potentially infectious materials. Food and drink may not be
temporarily placed on any surface, which may be contaminated, or near any device that may
generate splashes, sprays, or droplets of blood or other potentially infectious materials.
All procedures will be conducted in a manner that will minimize splashing, spraying splattering,
and generation of droplets of blood or other potentially infectious materials. The method that will
be employed at this facility to accomplish this goal is to have covers on all centrifuges used in
the laboratory.
Decontamination of Laboratory Equipment Prior to Servicing
Any contaminated laboratory equipment, or other equipment that may come into contact with
blood or other potentially infectious materials, being transferred or shipped for servicing shall be
decontaminated prior to transport. In the case of highly technical or sensitive equipment and/or
equipment with limited access to contaminated parts, at least partial decontamination shall be
performed.
Transportation of Specimens and Other Potentially Infectious Materials
Blood samples and other potentially infectious materials being transported between clinics or
other campus locations shall be placed in a container that prevents leakage during transport. The
container shall be red or red-orange or labeled with the biohazard symbol. If the materials are
capable of puncturing their container, the primary container shall be placed within a secondary,
puncture-resistant container.
Blood-contaminated waste and other potentially infectious materials being disposed of in any
location shall be placed in a biohazard container that prevents leakage during storage. The
container shall be red or red-orange or labeled with the biohazard symbol. If a container shows
70 evidence of contamination on the outside of the container, or if leakage of contents has occurred,
the primary container should be placed in a secondary container and removed for proper
disposal. Infectious waste shall not be placed in ordinary waste disposal containers. Any
contaminated sharps shall be disposed of as described previously in this plan.
Mouth Pipetting / Suctioning
Mouth pipetting or suctioning of specimens is strictly prohibited.
Personal Protective Equipment
All garments that are penetrated by blood shall be removed immediately or as soon as feasible.
All personal protective equipment will be removed prior to leaving the work area. The following
protocol has been developed to facilitate leaving the equipment at the work area:
Personal Protective Equipment
Storage Site
Gloves (laboratory)
Single-use gloves are disposed after use
Lab Coat (Clinic Lab)
Clinic Laboratory
Janse Hall Phlebotomy (Lab Diagnosis) Laboratory
Interdisciplinary Research Laboratory
Protective eyewear
With endoscopic kits
Clinic Laboratory
Interdisciplinary Research Laboratory
Utility Gloves
Clinic Laundry
Maintenance Department
Examination Gloves
Single-use gloves are disposed after use
Use of Gloves
Disposable (single-use) gloves shall be worn when performing venipuncture, acupuncture, when
in contact with blood, mucous membranes, non-intact skin, or potentially infectious materials is
anticipated, or when handling or touching contaminated items or surfaces.
Gloves shall be available in the following sites: patient examination rooms, clinical laboratory,
patient records/dispensary, electrodiagnosis room, colonic irrigation room, radiology suites,
Interdisciplinary Research Laboratory, Janse Hall Phlebotomy (Laboratory Diagnosis)
Laboratory, Physiology Laboratory, Biochemistry Laboratory, chiropractic technique and
anatomical laboratories. Disposable (single-use) gloves may not be reused.
Powderless gloves or hypoallergenic gloves will be available in each facility for use by interns
who need them.
Reusable (utility) gloves shall be used by laundry personnel when handling potentially
contaminated linens. These should be decontaminated after each use and discarded if they show
71 signs of cracking, peeling, tearing, puncturing, deterioration, or failure to provide a protective
barrier. Disinfectants shall be germicidal and tuberculocidal.
Disposable Patient Gowns for Colonic Irrigation
Patients receiving colonic irrigation or enemas shall be gowned in paper, disposable gowns.
These gowns are to be placed in biohazard containers after use. Regular linen gowns shall not be
used on these patients, however if a linen gown is accidentally used, it shall be placed in a red
biohazard bag and taken to be autoclaved prior to being taken to the laundry.
Decontamination of Work Surfaces
Contaminated work surfaces must be decontaminated with a germicidal tuberculocidal
disinfectant upon completion of procedures or when contaminated by splashes, spills, or contact
with blood, other potentially infectious materials, and at the end of the work shift.
Countertops may be protected with nonabsorbent materials, however these must be inspected
frequently for contamination and changed when found to be contaminated.
Waste Cans and Pails
Waste cans and pails must be inspected and decontaminated on a regularly scheduled basis.
Waste cans and pails in patient rooms are to be used only for disposal of non-contaminated
materials; visibly contaminated materials are to be placed in biohazard containers.
Biohazard Labeling
Refrigerators and freezers that contain blood or other potentially infectious materials shall be
clearly labeled with the universal biohazard symbol.
Only the OSHA-approved universal biohazard symbol shall be used for labeling blood and
potentially infectious material containers at NUHS. That symbol must be black (or very dark) on
a red or orange-red background. Existing non-approved symbols will be replaced with the
approved label.
There will be no biohazard labeling of patients’ charts or laboratory specimens.
Resuscitation Equipment
One-use emergency airway resuscitation equipment will be available in each clinic.
Mouth-to-mouth resuscitation should not be performed if one-use resuscitation equipment is
available.
Patient Examination Equipment Disinfection
High-level disinfection is required for re-usable items that come in contact with mucous
membranes (e.g., reusable specula, endoscopes)
72 Approved types of disinfectants include:
• Gluteraldehydes (10 minutes minimum contact)
• Phenols or Iodophors (1 minute minimum contact)
Management of Exposure Incident
The following section has been taken from the NUHS Policy on Management of Employees and
Students Accidentally Exposed to Blood or Other Potentially Infectious Materials.
Upon any accidental percutaneous (needle stick, laceration, abraded or inflamed skin, or bite), or
permucosal (ocular or mucous membrane) exposure to blood and other potentially infectious
materials, the following steps shall be taken:
•
Clean the site of exposure as soon as possible. In the case of percutaneous exposure, the
area should be irrigated thoroughly with soap and water, while encouraging bleeding of
the site by squeezing the area. A topical disinfectant (Betadine) should then be applied
for at least one minute (exposed persons should be questioned about iodine sensitivity
prior to Betadine application). In the case of permucosal exposure, the surface should be
irrigated with water for at least 15 minutes.
•
Notify the exposed person’s supervisor and fill out an incident report form.
•
Obtain a blood sample from the person who was the source of exposure and test for
HBsAg (Hepatitis B surface antigen) and antibodies to HIV. Testing may be done on
existing blood samples without the patient’s consent in situations involving accidental
exposure of a health care worker in Illinois. The source patient’s name should be
included on the incident report form. The order for the test should not appear in the
patient’s medical record.
•
Determine if source patient is at high risk of HIV or HBV infectious (i.e., history of
homosexual or bisexual contact, IV drug abuser, hemophiliac, etc.).
•
If the source patient is seronegative for HBV and HIV, no further action is necessary
unless the source patient was determined to be at high risk of HBV or HIV. In this case,
HIV and HBV testing should be performed on the exposed persons at the time of the
exposure and in twelve (12) weeks. Written consent from the exposed person must be
obtained for HIV testing. Additionally, the exposed person should be advised to report
any acute febrile illness that occurs within 12 weeks after exposure.
•
If the source patient refuses to allow a sample of blood to be collected, if the source
patient has AIDS, if the source patient is positive for HIV, or if the source is unknown:
o Counseling should be arranged for the exposed person
o HIV testing should be performed as soon as possible, with written consent, and
repeated at 6 weeks, 12 weeks, 6 months, and 12 months after exposure.
73 o For at least the first 12 weeks, the exposed person should be advised on prevention
of transmission of bloodborne diseases (i.e., practice safe sexual practices, refrain
from blood donations, etc.)
•
If the source patient refuses to allow a sample of blood to be collected, if the source
patient has Hepatitis B, if the source patient is positive for HBsAg, or if the source is
unknown:
o Counseling should be arranged for the exposed person.
o The hepatitis B vaccination and anti-HBs (antibody to HB surface antigen) status (if
known) of the exposed person should be reviewed. If the exposed person has not been
vaccinated (or has not finished the vaccination series) against HBV, they will be
immediately referred for vaccination and administration of HB immune globulin. If
the exposed person has previously been vaccinated, testing for anti-HBs should be
done; if there is adequate antibody, no further treatment is necessary; however, if the
antibody level is inadequate, referral for HBIG and vaccination booster should be
performed.
o For at least the first 12 weeks, the exposed person should be advised on prevention
of transmission of bloodborne diseases (i.e., practice safe sexual practices, refrain
from blood donations, etc.)
Protocol for HIV Test-Positive Patients: Salvation Army Clinics
This protocol has been developed to assure that each patient is handled in a professional and
consistent manner. Every effort will be made to assure that each patient receives appropriate
medical follow-up and counseling and that each case is handled individually and confidentially.
1. Patients receiving physical examinations at the Salvation Army chiropractic clinics will
be questioned on current and previous drug use history and sexual contacts as well as
other factors that may predispose to AIDS.
2. All patients that test HIV-positive will be confirmed by the Western Blot before the
patient is informed of a test-positive.
3. Upon confirmation of the Western Blot, the patient will be informed that a positive test
has been received. At this time, the patient will be informed of the confidentiality and
reporting policies of the chiropractic clinic as they relate to the Salvation Army
administration.
4. Every effort will be made at this point to assure that the patient receives the appropriate
follow-up and counseling needed to assist in dealing with psychological and medical
problems that may arise.
5. Personnel will be identified within the staff at Salvation Army to assist the patient.
74 6. The patient will also be referred to either Freedom Center or the Sacred Heart Hospital
for medical evaluation.
7. If a diagnosis of AIDS is established, the patient will be referred to Howard Brown
Memorial Clinic or another appropriate facility for care.
8. If there are no symptoms to suggest AIDS, the patient will be referred to TPAN (test
positive awareness network) or another facility for appropriate follow-up care.
9. Every effort will be made to assign patients that test positive, but have not yet contracted
AIDS, to tasks that are not at risk for immune compromise.
These policies will be reviewed periodically and updated as new data become available.
75 NATIONAL UNIVERSITY OF HEALTH SCIENCES
Request and Consent for Testing for Antibodies to the Human Immunodeficiency Virus
Last Name
First Name
Middle Name
Address
City
Patient Number
Day Telephone
State
Sex
Zip Code
Race
Evening Telephone
Birthdate
Date of Request
1. I am requesting a blood test to detect the presence of antibodies to the Human Immunodeficiency
Virus (HIV), the virus that causes Acquired Immunodeficiency Syndrome (AIDS). I have been advised that
the procedure, which involves the withdrawal by needle of a small amount of blood for laboratory testing
(about 1-1/2 Tablespoons), may cause some slight discomfort at the site of entry of the needle, and that
the procedure has minimal risks, such as bruising, soreness, and a slight risk of infection.
2. I have been provided with information about the test for antibodies to the HIV virus, about the HIV
virus, and about AIDS, and I have been given the opportunity to ask questions regarding this information
and have my questions answered.
3. I have been informed that both my request for the HIV virus test and the test results are considered
confidential and will be released only to me except as required by law. This request form and the
laboratory report represent the only records that will be maintained on my test and its results by National
University of Health Sciences.
4. Personnel handling these records have been carefully selected and trained to ensure that procedures
for maintaining my privacy are followed without exception. The request form is maintained apart from the
laboratory report and both will be destroyed by shredding within
from the date of the test,
which is the retention period established in conformance with state law.
5. I will be solely responsible for seeking any further care that I might require, including immunization
when such a breakthrough occurs.
6. I understand that if the test results are positive that I will be provided information on counseling
services available to those infected with HIV virus and I will be advised to see a physician both for my
own health care and so that I might take adequate precautions to prevent transmission of the virus to
others.
7. I understand that if the test results are positive and that if I do not collect my test results within one
month of the date of this request, a diligent effort will be made to locate me. In order not to violate my
privacy, National University of Health Sciences will not identify itself in correspondence or its staff will not
identify themselves in any telephoned contact, but will simply request that I call the number of the facility. I
agree to assume all risks that may result if I do not collect my test results.
8. Because DuPage County law requires reporting of individuals with antibodies to the HIV virus, I
understand that if the test results are positive and after ensuring the accuracy of the test results, they will
be submitted to the DuPage County Health Department.
Signature of Individual
Date
76 Note: The following forms relating to HIV are subject to change because of revisions in public
health regulations.
NATIONAL UNIVERSITY OF HEALTH SCIENCES
Patient’s Billing Consent for HIV Testing
I consent to allow the disclosure of my name, address, birthdate, name of the test(s), and
the charge to Medicaid or other medical assistance programs.
Patient’s Full Name:
Birthdate:
Address:
City:
State:
Zip Code:
Medicaid Number:
I do not give my consent to release the name of the test(s) to my insurance company, or
medical assistance program. I will pay the bill myself.
Signature:
I also authorize the following persons or agencies access to my HIV antibody test results:
Name of Person/Agency
To
Date Valid
Name of Person/Agency
To
Date Valid
77 OSHA Compliance
Acknowledgement of Training
I acknowledge that I have watched the training program. I have completed the quiz
and reviewed any areas where I felt I needed more training or information.
Student Printed Name:
Student Signature:
Date of Completion:
Clinician’s Printed Name:
Clinician’s Signature:
78 Chapter
10
HIPAA Training and Compliance
Health Insurance Portability and Accountability Act
USES AND DISCLOSURES FOR TREATMENT, PAYMENT,
AND HEALTH CARE OPERATIONS
[45 CFR 164.506]
Background
The HIPAA Privacy Rule establishes a foundation of Federal protection for personal health
information, carefully balanced to avoid creating unnecessary barriers to the delivery of quality
health care. As such, the Rule generally prohibits a covered entity from using or disclosing
protected health information unless authorized by patients, except where this prohibition would
result in unnecessary interference with access to quality health care or with certain other
important public benefits or national priorities.
Ready access to treatment and efficient payment for health care, both of which require use and
disclosure of protected health information, are essential to the effective operation of the health
care system. In addition, certain health care operations—such as administrative, financial, legal,
and quality improvement activities—conducted by or for health care providers and health plans,
are essential to support treatment and payment. Many individuals expect that their health
information will be used and disclosed as necessary to treat them, bill for treatment, and, to some
extent, operate the covered entity’s health care business. To avoid interfering with an
individual’s access to quality health care or the efficient payment for such health care, the
Privacy Rule permits a covered entity to use and disclose protected health information, with
certain limits and protections, for treatment, payment, and health care operations activities.
How the Rule Works
What are Treatment, Payment, and Health Care Operations?
The core health care activities of “Treatment,” “Payment,” and “Health Care Operations” are
defined in the Privacy Rule at 45 CFR 164.501.
•
“Treatment” generally means the provision, coordination, or management of health care and
related services among health care providers or by a health care provider with a third party,
consultation between health care providers regarding a patient, or the referral of a patient
from one health care provider to another.
•
“Payment” encompasses the various activities of health care providers to obtain payment or
be reimbursed for their services and of a health plan to obtain premiums, to fulfill their
79 coverage responsibilities and provide benefits under the plan, and to obtain or provide
reimbursement for the provision of health care.
In addition to the general definition, the Privacy Rule provides examples of common
payment activities, which include, but are not limited to:
o
o
o
o
Determining eligibility or coverage under a plan and adjudicating claims;
Risk adjustments;
Billing and collection activities;
Reviewing health care services for medical necessity, coverage, justification of
charges, and the like;
o Utilization review activities; and
o Disclosures to consumer reporting agencies (limited to specified identifying
information about the individual, his or her payment history, and identifying
information about the covered entity).
•
“Health care operations” are certain administrative, financial, legal, and quality improvement
activities of a covered entity that are necessary to run its business and to support the core
functions of treatment and payment. These activities, which are limited to the activities listed
in the definition of “health care operations” at 45 CFR 164.501, include:
o Conducting quality assessment and improvement activities, population-based
activities relating to improving health or reducing health care costs, and case
management and care coordination;
o Reviewing the competence or qualifications of health care professionals, evaluating
provider and health plan performance, training health care and non-health care
professionals, accreditation, certification, licensing, or credentialing activities;
o Underwriting and other activities relating to the creation, renewal, or replacement of a
contract of health insurance or health benefits, and ceding, securing, or placing a
contract for reinsurance of risk relating to health care claims
o Conducting or arranging for medical review, legal, and auditing services, including
fraud and abuse detection and compliance programs;
o Business planning and development, such as conducting cost-management and
planning analyses related to managing and operating the entity; and
o Business management and general administrative activities, including those related to
implementing and complying with the Privacy Rule and other Administrative
Simplification Rules, customer service, resolution of internal grievances, sale or
transfer of assets, creating de-identified health information or a limited data set, and
fundraising for the benefit of the covered entity. General Provisions at 45 CFR
164.506.
A covered entity may, without the individual’s authorization:
•
Use or disclose protected health information for its own treatment, payment, and health care
operations activities. For example:
80 o A hospital may use protected health information about an individual to provide health
care to the individual and may consult with other health care providers about the
individual’s treatment.
o A health care provider may disclose protected health information about an individual
as part of a claim for payment to a health plan.
o A health plan may use protected health information to provide customer service to its
enrollees.
•
A covered entity may disclose protected health information for the treatment activities of any
health care provider (including providers not covered by the Privacy Rule). For example:
o A primary care provider may send a copy of an individual’s medical record to a
specialist who needs the information to treat the individual.
o A hospital may send a patient’s health care instructions to a nursing home to which
the patient is transferred.
•
A covered entity may disclose protected health information to another covered entity or a
health care provider (including providers not covered by the Privacy Rule) for the payment
activities of the entity that receives the information. For example:
o A physician may send an individual’s health plan coverage information to a laboratory
that needs the information to bill for services it provided to the physician with respect to
the individual.
o A hospital emergency department may give a patient’s payment information to an
ambulance service provider that transported the patient to the hospital in order for the
ambulance provider to bill for its treatment.
•
A covered entity may disclose protected health information to another covered entity for
certain health care operation activities of the entity that receives the information if:
o Each entity either has or had a relationship with the individual who is the subject of the
information, and the protected health information pertains to the relationship; and
o The disclosure is for a quality-related health care operations activity (i.e., the activities
listed in paragraphs (1) and (2) of the definition of “health care operations” at 45 CFR
164.501) or for the purpose of health care fraud and abuse detection or compliance. For
example: < A health care provider may disclose protected health information to a health
plan for the plan’s Health Plan Employer Data and Information Set (HEDIS) purposes,
provided that the health plan has or had a relationship with the individual who is the
subject of the information.
•
A covered entity that participates in an organized health care arrangement (OHCA) may
disclose protected health information about an individual to another covered entity that
participates in the OHCA for any joint health care operations of the OHCA. For example:
o The physicians with staff privileges at a hospital may participate in the hospital’s training
of medical students. Uses and Disclosures of Psychotherapy Notes. Except when
psychotherapy notes are used by the originator to carry out treatment, or by the covered
entity for certain other limited health care operations, uses and disclosures of
psychotherapy notes for treatment, payment, and health care operations require the
individual’s authorization. See 45 CFR 164.508(a)(2).
81 Minimum Necessary. A covered entity must develop policies and procedures that reasonably
limit its disclosures of, and requests for, protected health information for payment and health
care operations to the minimum necessary. A covered entity also is required to develop rolebased access policies and procedures that limit which members of its workforce may have access
to protected health information for treatment, payment, and health care operations, based on
those who need access to the information to do their jobs. However, covered entities are not
required to apply the minimum necessary standard to disclosures to or requests by a health care
provider for treatment purposes.
Consent. A covered entity may voluntarily choose, but is not required, to obtain the individual’s
consent for it to use and disclose information about him or her for treatment, payment, and health
care operations. A covered entity that chooses to have a consent process has complete discretion
under the Privacy Rule to design a process that works best for its business and consumers. A
“consent” document is not a valid permission to use or disclose protected health information for
a purpose that requires an “authorization” under the Privacy Rule (see 45 CFR 164.508), or
where other requirements or conditions exist under the Rule for the use or disclosure of protected
health information. Right to Request Privacy Protection.
Individuals have the right to request restrictions on how a covered entity will use and disclose
protected health information about them for treatment, payment, and health care operations. A
covered entity is not required to agree to an individual’s request for a restriction, but is bound by
any restrictions to which it agrees. See 45 CFR 164.522(a). Individuals also may request to
receive confidential communications from the covered entity, either at alternative locations or by
alternative means. For example, an individual may request that her health care provider call her
at her office, rather than her home. A health care provider must accommodate an individual’s
reasonable request for such confidential communications. A health plan must accommodate an
individual’s reasonable request for confidential communications, if the individual clearly states
that not doing so could endanger him or her. See 45 CFR 164.522(b).
Notice. Any use or disclosure of protected health information for treatment, payment, or health
care operations must be consistent with the covered entity’s notice of privacy practices. A
covered entity is required to provide the individual with adequate notice of its privacy practices,
including the uses or disclosures the covered entity may make of the individual’s information
and the individual’s rights with respect to that information.
HIPAA Frequently Asked Questions: Search FAQs by category at:
http://www.hhs.gov/ocr/privacy/hipaa/faq/index.html
OCR HIPAA Privacy
December 3, 2002
Revised April 3, 2003
82 HIPAA Privacy Compliance
Acknowledgement of Training
I acknowledge that I have watched the training program. I have completed the quiz
and reviewed any areas where I felt I needed more training or information.
Student Printed Name:
Student Signature:
Date of Completion:
Trainer’s Printed Name:
Trainer’s Signature:
83 84 Chapter
11
Business Office Procedures
Photocopying
•
Photocopying is restricted to materials from the patient record and is done during normal
business office hours.
•
No personal materials are to be photocopied on business office copiers.
•
A fee for photocopying is charged to the patient.
•
Only the clinic business office manager can authorize copying to be done by interns. A
request must be filed that contains the name of the patient requesting copies, data
submitted and number of copies needed.
•
Copies needed for the patient will be made immediately if approved by an attending
clinician and submitted with a current completed release form signed by the patient.
•
Other materials require the approval of the clinic director and business office manager
and will incur a copying fee payable at the time copies are made.
New Patients
New patients are scheduled at any convenient time for the attending clinician. Only the attending
clinician will authorize the overbooking of a schedule. All calls will be directed to the attending
clinician by the front desk. The attending clinician will direct the front desk to either overbook or
not and the patient will then be given the next most convenient appointment time.
A maximum of 120 minutes will be considered acceptable for the time needed to attend to the
usual new patient’s needs on the first visit. Emergency situations may alter this time span.
To assure the most equitable distribution of patient load across the clinical practices, the
following procedure for scheduling will be followed:
•
The new patient calling to schedule an appointment will be asked if they have been
referred to a specific doctor. If they have been directly referred to a specific attending
clinician, the appointment is made with that doctor.
85 •
If no direct referral is indicated, the patient will be asked if they have a time preference
for the morning or afternoon.
•
Once the shift preference has been determined, a rotation system of scheduling is in place
to distribute the new patients across the clinic system.
Patient Appointments
All appointments and/or rescheduling of appointments must be done by the patient through the
front desk personnel. Return visits are scheduled from the information entered at the top right
hand corner of the route slip by authorization of the attending physician. An entry in the upper
right corner of the route slip designated "d/c" means the patient is not to be rescheduled and
treatment is to be discontinued.
If a patient reschedules or does not keep their appointment, the front desk personnel will call the
patient to determine the circumstances of the missed appointment and reschedule them for a
future date, if appropriate. The front desk will forward all questions regarding care to the
attending physician for follow-up.
Interns MUST note in the medical record that a patient has rescheduled or missed an
appointment. Each medical file date stamp must have an entry next to it indicating what took
place on that date. Notation of reason for missing the appointment and date rescheduled should
be entered. The clinician must sign such entries.
Routing of Patients
After signing in, the Duty Intern escorts the patient to the treatment room and places the folded
route slip into the holder on the door. After the treatment is finished, the patient goes to the
cashier. The completed route slip MUST accompany the patient to the cashier station. File
entries are NOT to be made at the cashier’s station or the business office area. The next
appointment time should be listed in the upper right hand corner of the route slip.
Correct completion of the route slip includes making sure that all procedures carried out at the
treatment are listed on the route slip. Failure to list a service that was carried out will result in the
intern being personally financially responsible for the charge. The intern must write their threedigit intern number in the box to the left of the charged service. This will enable proper credit to
be granted. The date of the next visit must be listed in the upper right hand corner. The attending
physician must sign all route slips. The intern must not list fees for the services rendered, as this
is the responsibility of the cashier/business office.
All financial arrangements are made by the business office ONLY. No intern is to discuss or
otherwise indicate payment arrangements for patients. This is not the privilege of the intern.
Direct all financial questions to the business office and/or clinic director.
86 Chapter
12
Clinic Community Outreach Events
Clinic Community Outreach Hours Needed to Graduate – 20 Hours
All forms can be found at: http://clinicalinfo.nuhs.edu (See Appendix J & K)
•
The Dean of Clinics approves all events. The completed paperwork/forms need to be
submitted at least 2 weeks in advance of the event.
•
“Observed/assessed” CMT credits can be acquired only in the clinic setting. Interns can
still acquire “CMT” credits by providing manual services to participants at outreach
events.
•
When the event is approved, a Clinician or the Administrative Assistant to the Dean of
Clinics will communicate with the contact person for the event, not the intern. Interns
may research the event, event dates and event coordinator, but must then give the
information to the Clinician or Administrative Assistant to the Dean of Clinics.
•
Having a Clinician or Administrative Assistant to the Dean of Clinics as the contact
person will accomplish three things:
1. There will be one NUHS representative contacting all outside event coordinators.
2. The Clinician or Administrative Assistant to the Dean of Clinics will be more
knowledgeable as to what NUHS has to offer in all programs and can promote NUHS
appropriately.
3. Event information will be kept on file by the Clinician or Administrative Assistant to
the Dean of Clinics for future years and not lost when interns graduate.
COMMUNITY OUTREACH EVENT PROCEDURE
STEP 1: GET APPROVAL
To get approval to attend an outreach event, fill out the boxed part of the Outreach
Record sheet and give to the Administrative Assistant to the Dean of Clinics, Room 535.
(Aurora, Chicago and Florida, may email the records sheet to [email protected]) Please
include the location of the event and the event’s start and end times. Remember, NUHS
does not attend events where there is a monetary charge to participate.
The Administrative Assistant will give the form to the Dean of Clinics to approve or
deny. This will get the event on the books and reserve one of the three Outreach Storage
Bins, which contains materials that will be needed for the event. This also will get the
87 event on the calendar and eventually on the Outreach report that is sent monthly to the
NUHS vice presidents.
SIMULTANEOULY–
STEP 2: FIND A CLINICIAN
If an intern submitted the Outreach Record or the Clinician who submitted the event
cannot attend: Find a Clinician who is available to attend and supervise group. If intern
cannot find a Clinician, the Administrative Assistant will try to find one. Remember,
without a clinician in attendance, no treatments can be given; only marketing
materials can be handed out.
SIMULTANEOUSLY
STEP 3: CONTACT WITH EVENT COORDINATOR
If the Clinician has already confirmed attendance at the event with the event’s
coordinator, then this step is not needed. While the Administrative Assistant is finding
a Clinician to supervise the event, she will make contact with the event’s coordinator (per
the Dean’s request) to determine if NUHS is acceptable for participation.
If there are any specific questions regarding the event, note them on the initial paperwork
before it is submitted so the Administrative Assistant, who will then get the answers
while contacting the event’s coordinator to determine NUHS’ acceptability for
participation.
STEP 4: RECRUIT OTHER INTERNS
Recruit other interns to attend. In some cases, the Clinician will offer the event to his
interns first, but make sure there are enough interns to run the event.
STEP 5: A WEEK BEFORE THE EVENT
Stop by the Administrative Assistant’s office in Room 535 to remind her that an Outreach
Storage Bin or tent(s) has been reserved and that she has the paperwork and storage bin in
reserve for your event.
STEP 6: A DAY BEFORE THE EVENT
A day before the event, pick up the storage bin and/or tent(s) in Room 533. Inside the
storage bin you will find all that you will need for the event, but you will still need to
provide your own business cards. There are three Outreach Storage Bins for Lombard.
Florida, Aurora and Chicago have their own bins, but Chicago and Aurora will need to
make an appointment with the Administrative Assistant to pick-up their tent(s).
Outreach Storage Bin Contents:
• NUHS table cover
• Table wipes
• Rubber gloves
• Pens to write with. No pens for giving away! Phone # is incorrect!
88 •
•
•
•
•
•
•
Clipboards with Intake Forms
Weekly Outreach Tally Sheets
Table paper
Hand antiseptic
Samples of Bio Freeze
2 different NUHS brochures
Garbage bags
Tent(s)
• There are three tents – (two black and a red).
• Tents must be reserved one week in advance when verifying paperwork with the
Administrative Assistant. First come, first served basis.
• Two buckets of sand are also needed to weigh down the tents. Each bucket of
sand is 50 pounds in weight. It is mandatory to use the sand buckets due to a
previous accident.
STEP 7: ATTEND THE EVENT AND HAVE PAPERWORK PROPERLY SIGNED
•
•
•
Make sure to get patient signatures and Clinician’s approval signature.
Print names of patients on Tally Sheet.
Copies of all paperwork can also be found at: http://clinicalinfo.nuhs.edu
If this event is only for marketing or presentation purposes, different paperwork asking
for Credit Hours needs to be completed and approved by the Dean of Clinics. This
paperwork can also be found at: http://clinicalinfo.nuhs.edu
STEP 8: EVENT COMPLETED
•
If paperwork is filled out correctly and submitted for credit or record
maintenance, the event is closed and can be reported and Tally Credits entered.
•
Return Outreach Storage Bin and/or tents to Room 533, the day after the event or
the next business day.
STEP 9: AFTER EVENT
The Clinician who attends the event must grade the event from 1 to 5; 1 being an
excellent event that we should do again. Also there is a comment section, for making
notes about the event. Grades and comments can be sent by email to the Administrative
Assistant after the event.
FINAL NOTES
• In addition to earning outreach numbers needed to graduate, the main reason for
OUTREACH is to encourage more patients to visit our clinics AND to promote NUHS
and our services to the public.
89 •
•
•
Attending events that are more than 15 to 20 miles away from one of our clinics defeats
the purpose of getting more patients into those facilities.
Attending events during clinic hours needs special approval by the Dean of Clinics.
No “observed/assessed” CMT credits are allowed during outreach events. They are
only allowed within the clinic hours.
90 Chapter
13
NUHS Clinical Clerkship Program
Note: Appendices N, O, P and Q refer to this chapter.
NUHS is responsible for ALL education that is given to its students from beginning to
commencement and the outcomes of that education must be reflected on the NUHS student
transcript.
This is a responsibility that mandates that all individuals who teach our students, whether here or
in our clinic system or elsewhere are of a caliber that meets NUHS Academic Standards and the
NUHS Mission and Goals. This means that:
1. All people who teach our students must be approved faculty members.
2. All faculty members must be teaching from the same set of academic principles that are
guided by the “Programmatic Purpose Statements,” and the Institutional Mission and
Goals.
3. All instruction must meet the test of being broad scope primary care oriented (as required
by the CCE and CNME Standards).
Since January 2010 and in consequence of these factors, all doctors who function as adjunct
faculty, whether in the Ancillary Clinical Education (ACE) clerkship, the Community-Based
Internship (CBI), or the Clinical Clerkship Rotations (such as the VA program at Danville) are
chosen by the University. Any intern who wishes to serve part or all of an internship in an offcampus setting will first need to obtain a form from the Clinic Services Manager will need to be
approved by the respective clinician and the Dean of Clinics prior to taking the next step. Each
such intern will need to meet certain academic standards as well. Upon approval the intern will
be assigned to an appropriate clerkship.
The prerequisite steps needed for students to apply to work with an approved adjunct faculty
member can be found in Appendix N entitled “Clinical Clerkship Qualifications and Application
Requirements.”
The process for participating in a clinical clerkship can be found in Appendix O entitled
“Ancillary Clinical Experience (ACE) Basics” and in Appendix P entitled “Clinical Based
Internship (CBI) Basics.”
91 Clerkship Frequently Asked Questions
Students should be sure to read the following information before contacting the Administrative
Assistant to the Dean of Clinics, Vicki Shargo, with any questions or requests for application
forms. Answers to the most commonly asked questions can be found here.
Once interns are in their 9th trimester and have completed the prerequisites, they should follow
the following steps:
Step 1 – Interns
Read the three definition sheets (“Clinical Clerkship Qualifications and Application
Requirements,” “Ancillary Clinical Experience (ACE) Basics” and “Clinical Based Internship
(CBI) Basics”) and become familiar with all the prerequisites.
Step 2 – Interns
When interns reach their 9th trimester and have met all of the prerequisites, they will need to
contact the Administrative Assistant to the Dean of Clinics, Vicki Shargo, for the “NUHS
Clinical Clerkship Program – Intern Eligibility Form.” After the Registrar and all the other
necessary individuals have signed the form, the intern will be given the appropriate application
to complete.
Once the intern returns the completed application and requested paperwork to the Administrative
Assistant to the Dean of Clinics, the intern will be told when he has been approved and is
available to start the clerkship. The intern will then be asked to fill out the “Clinical Clerkship
Program Assignment Request Form,” which will give the starting and ending dates and times for
the clerkship. This form must be signed by the following:
• Adjunct faculty member doctor
• Intern’s attending clinician
• Chair of Clinical Practice
• Clinic Services Manager
• Dean of Clinics
• Intern
Once this form is completed and returned to the Clinic Services Manager, the clerkship can begin
on the agreed upon start date.
In some cases, an intern may want to carry out their clerkship with a specific doctor who has not
been formally approved by the university’s Clinical Clerkship Committee. To allow enough time
for the doctor to complete the application process, the doctor can apply during the intern’s 8th
trimester to early 9th trimester.
A CBI clerkship doctor needs to be located within 75 miles of any of the NUHS clinics and have
radiology equipment on site, so the intern is able to complete his numbers needed to graduate.
In an ACE clerkship, the intern must have all their numbers needed to graduate completed and
approved by the Clinic Services Manager before they are allowed to begin their clerkship.
92 The doctor must complete the following steps in sufficient time for their application to be
processed through committee:
Step 1 – Interested Doctors
1. Send a letter of interest on practice letterhead addressed to: Dr. Theodore L. Johnson, Jr.,
Dean of Clinics. If they have a specific intern in mind, the intern’s name should be
mentioned in the letter of interest.
2. Send a current CV.
3. Both the letter and CV Both documents can be emailed to [email protected]
Step 2 – Applying Doctors
Once the letter and CV are received, the appropriate application will be sent to the doctor to
complete and return with the additional paperwork requested in the application. Please note: If
the doctor has other doctors in his practice that will also be teaching the intern, they, too, must
fill out their own application form and be approved.
Step 3 – Approval of Applicants
1. Once the doctor has returned the application and additional paperwork, the application
file is sent to the Clinical Clerkship Committee, a group of five faculty members, who
will review the application.
2. Once all five members have graded the application, they will give their recommendation
to the Dean of Clinics, who can agree or disagree with the committee.
3. Next, the application and recommendation is given to the Vice President for Academic
Services (VPAS), who can agree and disagree.
4. The committee recommendation plus the recommendation of the VPAS is then given to
the President, who can agree or disagree with the committee, dean and VPAS.
5. The President then gives the final decision to the Dean of Clinics who will then notify the
doctor whether he has been approved or denied. If the doctor is approved, he stays on the
approved list as long as his license, malpractice insurance policy and CV are current.
Intern Observations
If interns are not eligible to go on a clerkship, interns may choose to go on observations with
doctors of their choice for a total of up to 10 days. They may do so in their 10th trimester after all
their clinical requirements to graduate are completed, turned in, and approved by the Clinic
Services Manager.
There is a form to fill out titled “Request for Independent Clinic Observation” which can be
found on the inner web site: http://clinicalinfo.nuhs.edu, or can be obtained from Clinic
Services Manager Jean Fairbank. A copy of the doctor’s license must be attached to the
form. However, the deadline for completion of observation paperwork must be completed
by the third Thursday prior to graduation. See Appendix Q.
93 94 Appendix
95 96 Appendix A
CCE Standard H: Educational Requirements for
Doctor of Chiropractic Program
CCE Meta-Competencies & Guidelines
(Appendix 1)
(Effective 1/1/12)
Manual of Policies of The Council on Chiropractic Education
January 2011
The DCP is required to demonstrate that its students have achieved the mandatory meta-competencies and
their required components and outcomes noted below. Within the constraints of the meta-competencies
and evidence-informed assessment techniques, each DCP is free to determine its own method of metacompetency delivery and assessment. Ultimately, the DCP is accountable for the quality and quantity of
its evidence of compliance with the meta-competencies and their required components and outcomes.
A meta-competency assessment guide, Guidelines for DCP Assessment of Meta-Competencies, is
attached to this policy. The guide is designed to provide insight into several options for documenting
success in achieving the competency requirements. The guidelines are not meant to be all inclusive or
prescriptive with respect to the evidence necessary to demonstrate compliance.
CCE Clinical Education Meta-Competencies
A graduate of a CCE accredited DCP is competent in the areas of:
META-COMPETENCY 1 - ASSESSMENT & DIAGNOSIS
An assessment and diagnosis requires developed clinical reasoning skills. Clinical reasoning consists of data
gathering and interpretation, hypothesis generation and testing, and critical evaluation of diagnostic
strategies. It is a dynamic process that occurs before, during, and after the collection of data through history,
physical examination, imaging, and laboratory tests.
REQUIRED COMPONENTS:
A. Compiling a case-appropriate history that involves a process focused on patients’ health status, including a
history of any present illness, systems review, and review of past, family and psychosocial histories for the
purpose of directing clinical decision-making.
B. Determining the need for and availability of external health records.
C. Performing case-appropriate physical examinations that include evaluations of body regions and organ systems,
including the spine and any subluxation/neuro-biomechanical dysfunction that assist the clinician in developing
the clinical diagnosis(es).
D. Utilizing diagnostic studies and consultation when appropriate, inclusive of imaging, clinical laboratory, and
specialized testing procedures, to obtain objective clinical data.
E. Formulating a diagnosis (es) supported by information gathered from the history, examination, and diagnostic
studies.
OUTCOMES:
1. Documentation of a list of differential diagnosis (es) and corresponding exams from a case-appropriate health
history and review of external health records.
97 2.
Determination and documentation of the significance of physical findings and thereby the need for follow-up
through a physical examination, application of diagnostic and/or confirmatory tests and tools, and any
consultations.
3.
Generation of a problem list with diagnoses after synthesizing and correlating data from the history, physical
exam, diagnostic tests, and any consultations.
META-COMPETENCY 2 - MANAGEMENT PLAN
Management involves the development, implementation and documentation of a patient care plan for
positively impacting a patient’s health and well-being, including specific therapeutic goals and prognoses. It
may include case follow-up, referral, and/or collaborative care.
REQUIRED COMPONENTS:
A. Establishing a management plan appropriate for the diagnosis and the patient’s health status, including specific
therapeutic goals and prognoses.
B. Determining the need for emergency care, referral and/or collaborative care.
C. Providing information to patients of risks, benefits, natural history and alternatives to care regarding the
proposed management plan.
D. Obtaining informed consent.
E. Determining the need for chiropractic adjustment and/or manipulation procedures, or other forms of passive
care.
F.
Determining the need for active care.
G. Determining the need for changes in patient behavior and activities of daily living.
H. Monitoring patient progress and altering management plans accordingly.
I.
Recognizing the point of a patient’s maximum therapeutic benefit and release of the patient from corrective
care, and communicating rationales for any ongoing care.
J.
Incorporating patient values and expectations of care in the management plan.
OUTCOMES:
1. Formulation and documentation of an evidence-informed management plan appropriate to the diagnosis,
inclusive of measureable therapeutic goals and prognoses in consideration of bio-psychosocial factors, natural
history and alternatives to care.
2.
Documentation of informing the patient of any need for emergency care, referral and/or collaborative care.
3.
Documentation of informed consent.
4.
Deliverance and documentation of appropriate chiropractic adjustments/manipulations, and/or other forms of
passive care as identified in the management plan.
5.
Deliverance and documentation of appropriate active care as identified in the management plan.
6.
Documentation of patient counseling regarding recommended changes in the life style behaviors and activities
of daily living.
7.
Documentation of modifying the management plan as new clinical information becomes available.
98 8.
Documentation of end points of care.
META-COMPETENCY 3 - HEALTH PROMOTION AND DISEASE PREVENTION
Health promotion and disease prevention requires an understanding and application of epidemiological
principles regarding the nature and identification of health issues in diverse populations and recognizes the
impact of biological, chemical, behavioral, structural, psychosocial and environmental factors on general
health.
REQUIRED COMPONENTS:
A. Assessing the patient’s health and determining areas of potential health improvement (e.g. disease screening,
ergonomics, nutrition, fitness, posture, smoking cessation, and risk factor reduction.)
B. Addressing appropriate hygiene in a clinical environment.
C. Coordinating health improvement strategies with other health care professionals.
D. Identifying public health issues relevant to patients.
OUTCOMES:
1. Documentation of management of health risks and public health issues, including reporting, as required.
2.
Explanation of health risk factors, leading health indicators and public health issues to patients.
3.
Provision of recommendations regarding patient’s health status, behavior and life style.
4.
Recommendation or provision of resources (educational, community-based, etc.) and instruction designed to
encourage a patient to pursue change.
5.
Recommendation of dietary habits and/or nutritional approaches designed to restore, maintain or improve the
patient’s health.
6.
Implementation of appropriate hygiene practices in the clinical environment.
7.
Communication of health improvement strategies with other treating health professionals.
META-COMPETENCY 4 - COMMUNICATION AND RECORD KEEPING
Effective communication includes oral, written and nonverbal skills with appropriate sensitivity, clarity and
control for a wide range of healthcare related activities, to include patient care, professional communication,
health education, and record keeping and reporting.
REQUIRED COMPONENTS:
A. Communicating effectively, accurately and appropriately, in writing and interpersonally with diverse
audiences (e.g. patients, their relatives and others involved in their care; regulatory agencies, third party
payers and employers; and doctors of chiropractic and other healthcare professionals).
B. Acknowledging the existence and nature of different value systems of patients and others.
C. Creating and maintaining accurate and legible records.
D. Complying with regulatory ethical standards and responsibilities involving patient and business records.
99 OUTCOMES:
1. Provision of accurate and understandable explanations of health issues and management options considering the
patient’s health care needs and goals.
2.
Documentation of any health risks and management options considering the patient’s health care needs and
goals.
3.
Generation of patient records, narrative reports and correspondences that are accurate, concise and legible.
4.
Evidence of safeguarding the patient’s protected health and financial information.
META-COMPETENCY 5 - PROFESSIONAL ETHICS AND JURISPRUDENCE
Professionals comply with the law and exhibit ethical behavior.
REQUIRED COMPONENTS:
A. Applying knowledge of ethical principles and boundaries.
B. Applying knowledge of health care law.
C. Applying knowledge of expected professional conduct.
OUTCOMES:
1. Maintenance of appropriate physical communication (verbal and non-verbal) and emotional boundaries with
patients.
2.
Maintenance of professional conduct with patients, peers, staff, and faculty in accordance with established
policies.
3.
Compliance with the ethical and legal dimensions of clinical practice.
4.
Generation of patient records and diagnostic and billing codes in compliance with federal and state law.
META-COMPETENCY 6 - INFORMATION AND TECHNOLOGY LITERACY
Information and technology literacy are manifested in an ability to locate, evaluate and integrate research
and other types of evidence, including clinical experience, to explain and manage health-related issues and use
emerging technologies appropriately.
REQUIRED COMPONENTS:
A. Demonstrating knowledge of relevant research methodologies and ability to critically appraise and apply the
literature to clinical cases.
B. Using health informatics to access information.
OUTCOMES:
1. Critical appraisal of scientific literature and other information sources.
2.
Incorporation of health care informatics into patient care.
META-COMPETENCY 7 - INTELLECTUAL AND PROFESSIONAL DEVELOPMENT
Intellectual and professional development is characterized by maturing values and skills in clinical practice;
the seeking and application of new knowledge; and the ability to adapt to change.
100 REQUIRED COMPONENTS:
A. Demonstrating knowledge of basic, social and clinical sciences sufficient to promote intellectual development
and effective patient care.
B. Reflecting on and addressing personal and professional learning issues.
C. Providing evidence of critical thinking skills.
OUTCOMES:
1. Satisfactory performance on licensing board exams and other assessments of student learning.
2.
Use of appropriate self-evaluation and other feedback for personal and professional development.
3.
Incorporation of critical thinking and clinical experience into patient care.
CCE Guidelines
Guideline for DCP Assessment of Learning of Meta-Competencies
CCE Meta-Competencies are assessable learning outcomes to be measured at the student and program
levels.
The DCP utilizes a system of student assessment and evaluation that is based on the goals, objectives,
competencies and learning outcomes established by the DCP, as well as the Meta-Competencies defined
by the CCE Standards and appropriate to entry-level chiropractic practice. The system must clearly
identify the level of performance expected of students in the achievement of these objectives,
competencies, and outcomes.
As a component of its assessment plan, the DCP develops and carries out program assessment activities to
collect information about the attainment of Meta-Competencies and the other DCP competencies, which
are desired student-learning outcomes. The assessment activities employ a variety of valid and reliable
direct and indirect measures, systematically and sequentially throughout the professional degree program.
At the program level, it is suggested that learning is assessed using a minimum of two direct measures
and one indirect measure that reflect learning close to or at the end of the program. Assessment methods
and tools are appropriate for the type of learning that is assessed. Direct measures include student
products or performances that demonstrate that specific learning has taken place, including reports,
exams, demonstrations, performances, and completed works. Indirect measures may imply that learning
has taken place (e.g., student perceptions of learning), but do not specifically demonstrate that learning or
skill. Such perceptions can come from many perspectives, including students, faculty, internship
supervisors, alumni, transfer institutions, and employers. Because each method has its limitations, an
ideal assessment program would combine direct and indirect measures from a variety of sources.
Examples of direct measures of student learning relative to the knowledge component of taking a patient
history include student performance on a course written exam and relevant NBCE sub scores on Patient
History found in the Part II & III exams. Direct measures of student performance relative to taking a
patient history include Objective Structured Clinical Exams (OSCEs), clinical Qualitative Evaluations
(QE) and Part IV scores related to history taking.
Examples of indirect measures of student learning relative to the knowledge and performance
components of taking a patient history include student surveys of their perception of their knowledge and
ability, employer surveys, and course evaluations.
101 Results obtained through assessment of student learning are made available to appropriate constituencies,
including students themselves. The DCP uses the analysis of assessment measures to improve student
learning and the achievement of the Meta-Competencies.
Examples of Direct Measures of Learning of Meta-­‐Competencies -­‐ Performance scores on Standardized Tests (sub scores on NBCE exams related to specific meta-­‐
competencies) -­‐ Course written & Practical exams related to meta-­‐
competencies -­‐ Graded patient file audits -­‐ Clinical OSCEs -­‐ Direct observations in a clinical setting -­‐ Case Studies -­‐ Relevant internships/clinical experiences with evaluation -­‐ Performance based projects w ith evaluation -­‐ Graded presentations (individual or group) -­‐ Portfolio evaluation -­‐ Research and o ther published papers -­‐Progressive disclosure case studies Examples of Indirect Measures of Learning of Meta-­‐Competencies -­‐ Student Satisfaction relative to their perception of their knowledge/ability regarding a given meta-­‐
competency -­‐ Global Rating Scales -­‐ Preceptor surveys -­‐ Classroom assessment techniques -­‐ Clinical mentor evaluations CCE Guideline for Measuring Program Effectiveness
Along with assessment of learning of Meta-Competencies, each DCP provides evidence of overall
program effectiveness through a variety of valid and reliable measures that assess the impact of the
curriculum and co-curriculum on learning.
Measures include data with thresholds for success. Examples of measures are found in the table below.
Results obtained through program assessment are made available to appropriate constituencies. The DCP
uses the analysis of assessment measures for continuous improvement of its curriculum and cocurriculum.
102 Examples of Direct Measures of the DCP Examples of Indirect Measures of the DCP -­‐ NBCE pass rates -­‐ CCEB pass rates -­‐ OSCE pass rates -­‐ Student publication counts -­‐ Evaluation of off-­‐site clinical experiences -­‐ Student portfolio evaluations -­‐ External accreditation reviews -­‐ Course pass rates -­‐ Clinical qualitative evaluation scores -­‐ Patient quality assurance data/analyses -­‐ Progressive disclosure case studies Approved: 1/14/11 Revised: N/A -­‐ Satisfaction (Student, Patient, Alumni, Employer) -­‐ Preceptorship rates -­‐ Title IV Loan default rates -­‐ Graduating class GPA -­‐ Graduate placement -­‐ Licensure rates -­‐ Enrollment percentage -­‐ Diversity of student and staff populations -­‐ Retention rates -­‐ First year completion rates -­‐ Graduation rates -­‐ Transfer ratios -­‐ Community services (clinical care) -­‐ Community partnerships -­‐ Extramural grants -­‐ Faculty publications/presentations -­‐ Student complaint percentage -­‐ Articulation agreements w ith o ther colleges -­‐ Faculty publication rates -­‐ Faculty retention 103 104 Appendix B
The NUHS College of Professional Studies Competencies
NUHS Competency Domain
Description of Performance Standard
I. Medical Knowledge
The competent graduate employs evidence
informed practices, demonstrating good clinical
care and developing medical expertise.
II. Interpersonal and Communication Skills
The competent graduate develops and assesses
communication skills, developing an ability to
work in health care teams.
III. Patient Care
The competent graduate fosters the ability to
deliver patient-centered care, develops the doctor’s
ability to teach, train, appraise, and assess, and
develops collaborator skills.
IV. Professionalism
The competent graduate develops and assesses
appropriate ethical relationships with patients,
peers and subordinates, and develops and assesses
the doctor’s ability to present themselves in a
professional manner both in appearances and
actions.
V. Practice-Based Learning and Improvement
The competent graduate develops the ability to
apply quality improvement methods both through
self and peer assessments.
VI. Systems-Based Practice
The competent graduate develops the ability to
understand roles in current health care models
(medical, home, multidisciplinary practice,
hospital-based practice).
105 106 Appendix C
Quantitative Requirements for Graduation
Amount
Skill or task
Specific Criteria
350
Patient encounter (patient visit)
20
History
25
Examination
10
Gynecological Examination
10
20
Proctological Examination
Hematology (i.e., CBC)
– Interpretations on all 20 procedures and/or profiles performed
20
Chem/Micro/Immuno
– Interpretations on all 20 procedures and/or profiles performed
25
Urinalysis (UA)
– Interpretations on all 25 procedures performed
25
Venipuncture
– 10 are required for graduation
30
Radiographic Studies
20
Diagnosis
250
CMT
75
Observed CMT
35
PT/Rehab
35
Evaluation & Management5
15
File Audits
20
Case Reports/Narratives
20 hours
Clinic Community Outreach
20 hours
University Service Credit
1350 hrs
Minimum Practical Clinical
Experience
Mandatory
Pink slips must be presented at
graduation rehearsal.
– Performed on 20 different patients
– 80% must be on non-student patients1
– Performed on 20 different patients
– 80% must be on non-student patients
– 15 different case types2
– All 30 must be evaluated for the technical component (Diagnostic Imaging
Dept.)
– All 30 must be evaluated for the interpretive component (OAP note)
– 15 different case types3
– Performed on 20 different patients
– 80% must be on non-student patients each w/ defined case management plans
– 15 different case types each w/ defined case management plans4
– 80% must be spinal adjustments provided during 250 separate encounters
– 80% must be non-student patients of which 75 are assessed (see below)
– Assessed through direct observation of non-student spinal adjustments
– 20 cases must be live-patient cases6
– 80% must be non-student patients
– 15 File Audits are required for graduation
– 5 narratives required in Clinic Internship I
– 10 narratives required in Clinic Internship II
– 5 narratives required in Clinic Internship III
– Must complete requirement while enrolled in Clinic Internship I and/or II
– Clinician must be present for credit
– Administered by the Office of the Dean of Clinics
– See Appendices J & K
– Must complete requirement prior to graduation
– Administered by the Office of the Registrar
– 350 hours, Clinic Internship I
– 525 hours, Clinic Internship II
– 525 hours, Clinic Internship III
One week prior to Pink Slip Day, all graduating 10th Trimester students must
check in with Clinic Services Manager Jean Fairbank to make sure all
Quantitative Requirements for Graduation have been completed and received,
and that all clinic accounts have been paid. Pink slips will be issued once are
requirements have been met.
See Footnotes on next page
107 Appendix C Footnotes:
1 A non-student patient is any patient that is not a student of the DC program and a student intern’s spouse, parents or children.
2 Which may be included among the 20 different patients, or in which the student may assist, observe, or participate in live, paper-based,
computer-based, distance-learning, or other reasonable alternative. Case types = diagnostic entities (i.e., lumbar disc herniation,
hypertension), patient presentations (i.e., woman with fatigue, patient over 50 w/ insidious low back pain, patient w/ radiating arm pain &
nerve root deficits), and/or functional articular lesions (i.e., Maigne’s syndrome, upper cervical joint dysfunction causing cervicogenic
headache).
3 Which may be included among the 30 radiographic studies, or in which the student may assist, observe, or participate in live, paper-based,
computer-based, distance-learning, or other reasonable alternative.
4 Which may be included among the 20 different patients, or in which the student may assist, observe, or participate in live, paper-based,
computer-based, distance-learning, or other reasonable alternative.
5 These cases, due to their complexity, require a higher order of clinical thinking and integration of data. This would include cases, which
demand the application of imaging, lab procedures or other ancillary studies in determining a course of care, or cases in which multiple
conditions, risk factors, or psychosocial factors have to be considered.
6 In the remaining cases, the student may assist, observe, or participate in live, paper-based, computer-based, distance-learning, or other
reasonable alternative.
108 Appendix D
Clinic Internship I Syllabus
COURSE TITLE: Clinic Internship I
TIME REQUIREMENT: (hrs/week)
COURSE NUMBER: IC700
Course Credits: 11
Laboratory: 18 hours x 15 weeks & 30 hours x 2 weeks
Total Clock Hours: 330
PREREQUISITES: Completion of Phase I; Current CPR Certification; EC6303; FR6307; RA6302
COREQUISITES: EM6403, RA6409, RA6408
COMPETENCIES GUIDING THE COURSE:
1. Medical Knowledge
2. Interpersonal and Communication Skills
3. Patient Care
4. Professionalism
5. Practice-based Learning and Improvement
6. Systems-based Practice
Given the particular needs of assessment within the clinical setting, some of these core competences are evaluated in
a targeted manner during the course of patient encounters. Below are listed the various areas where the Clinic
Internship I student must show an appropriate introductory level of mastery before being allowed to work without a
senior intern mentor. These are further described in Intern Manual Appendix A - CCE Standard H: Educational
Requirements for Doctor of Chiropractic Program
META-COMPETENCY 1 - ASSESSMENT & DIAGNOSIS
An assessment and diagnosis requires developed clinical reasoning skills. Clinical reasoning consists of data
gathering and interpretation, hypothesis generation and testing, and critical evaluation of diagnostic strategies. It is
a dynamic process that occurs before, during, and after the collection of data through history, physical
examination, imaging, and laboratory tests.
META-COMPETENCY 2 - MANAGEMENT PLAN
Management involves the development, implementation and documentation of a patient care plan for positively
impacting a patient’s health and well-being, including specific therapeutic goals and prognoses. It may include
case follow-up, referral, and/or collaborative care.
META-COMPETENCY 3 - HEALTH PROMOTION AND DISEASE PREVENTION
Health promotion and disease prevention requires an understanding and application of epidemiological principles
regarding the nature and identification of health issues in diverse populations and recognizes the impact of
biological, chemical, behavioral, structural, psychosocial and environmental factors on general health.
META-COMPETENCY 4 - COMMUNICATION AND RECORD KEEPING
Effective communication includes oral, written and nonverbal skills with appropriate sensitivity, clarity and
control for a wide range of healthcare related activities, to include patient care, professional communication, health
education, and record keeping and reporting.
META-COMPETENCY 5 - PROFESSIONAL ETHICS AND JURISPRUDENCE
Professionals comply with the law and exhibit ethical behavior.
109 META-COMPETENCY 6 - INFORMATION AND TECHNOLOGY LITERACY
Information and technology literacy are manifested in an ability to locate, evaluate and integrate research and other
types of evidence, including clinical experience, to explain and manage health-related issues and use emerging
technologies appropriately.
META-COMPETENCY 7 - INTELLECTUAL AND PROFESSIONAL DEVELOPMENT
Intellectual and professional development is characterized by maturing values and skills in clinical practice,
the seeking and application of new knowledge, and the ability to adapt to change.
GENERAL COURSE DESCRIPTION:
IC7000 Clinic Internship I - Credits 11:Clinic Internship I, although designated as a laboratory in a curricular sense,
marks the advent of the student's practical application of the basic and clinical sciences in a clinical setting. Students
will receive close supervision, guidance and instruction in the delivery of health care by licensed clinical personnel
as well as mentoring by senior interns. Students participating in clinical experiences are expected to exhibit clinical
competence and professionalism (including knowledge of and strict adherence to confidentiality and privacy
policies). Clinic Internship I operations will closely mirror the experiences of Clinic Internship II and III, including
but not limited to clinic forms, diagnostic and therapeutic procedures. In each clinical experience (I, II, III),
responsibilities are granted interns based upon the clinician’s assessment that patient care competencies have been
mastered. Clinical competencies relating to the skills of historical interviewing, medical record documentation,
physical examination (general, regional and specialty), laboratory testing (selection, performance and interpretation),
evidence-based therapeutics, differential diagnoses development, ethics, professionalism, and interpersonal
communication will be assessed (Competencies 1-7).
Prerequisites: Completion of Phase I, Current CPR Certification; EC6303; FR6307; RA6302
Corequisites: EM6403, RA6408, RA6409
COURSE OBJECTIVES:
Upon completion of the course the student will be able to:
1. Assess the completeness of the initial patient intake information.
2. Interview patients to discover the parameters of their presentation and any other contributing factors.
3. Select the appropriate examination procedures that would result in robust data concerning the patient’s
presentation.
4. Record history and examination findings utilizing the proper forms in the patient’s file.
5. Determine the working diagnosis as a result of the subjective and objective findings.
6. Design a treatment plan that is within the best practices as supported by current research.
7. Apply the procedures as outlined in the patient’s treatment plan.
8. Monitor the patient’s progress as they receive treatments according to the set treatment plan.
9. Detect inappropriate reactions to the set treatment protocols.
10. Revise the treatment plan for further care based upon the patient’s progress and know when to discharge a
patient from care.
INSTRUCTIONAL MATERIALS:
Required Texts:
All previously utilized texts required for the previous clinical sciences courses will be considered required and will
be referred to on a regular basis in the course of patient evaluation and management.
Recommended/Supplemental Texts:
Muscles: Testing and Function, with Posture and Pain
By Florence Peterson Kendall (Editor), Elizabeth Kendall McCreary (Author), Patricia Geise Provance, Mary
McIntyre Rodgers, William Anthony Romani
Publisher: Lippincott Williams & Wilkins; Fifth Edition (February 1, 2005)
ISBN-10: 0781747805
110 Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 1. The Upper Half of Body by Janet G.
Travel & Lois S. Simons
Publisher: Lippincott Williams & Wilkins; 2nd edition (November 1, 1998)
# ISBN-10: 0683083635
Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 2; The Lower Extremities
ISBN-10: 0683083678
Other Required/Recommended Instructional Materials:
In addition, the kit of diagnostic equipment given to students at the beginning of their career at National University
of Health Sciences should be with them every day. If they are found to be without these essential tools, they will
receive an unexcused absence for each day they are present without this gear.
Orientation
During the first week of classes, Clinic Internship I interns will not be seeing patients in clinic. This period is given
over to ensuring that a set of basic practical skills and/or administrative functions has been covered. Be it
appropriate forms, procedures or constructs for understanding the “flow” of a patient within the clinic or the
ordering of radiographic images or laboratory studies, exposure prior to undertaking patient care lays the foundation
for effective care and the efficient use of time. During this week, the normal clinic dress code is suspended.
Self-Study
It has been the experience of successful doctors that nearly every patient encounter triggers some degree of
additional study, especially early in their careers. This course is patient case driven, and self-directed study outside
of the clinic is expected. The cases will originate from the patients that interns treat within the clinic and those which
are presented during the regular case discussions.
EVALUATION OF STUDENT’S ACHIEVEMENT:
Compared to the rest of a student’s career at National, entrance into the clinic system, starting with Clinic Internship
I marks a definitive change. Students are now responsible for the health and well being of the patients under their
care. This is a simple but profound statement, underlying the added charge being laid upon the student. With this in
mind, the bar is set higher for passing in this setting.
Grading Procedure:
Course grade is Pass/Fail (70%).
Assessment will be based on:
• Evaluations generated for intern performance while in the clinic will be performed by the clinicians using
ECQES (40% of the grade). The interns will need to be assessed by the staff clinicians in the following
categories with different patients. It will be the student’s responsibility to seek out a clinician to observe
their activities in the following categories:
o Manipulative Therapy (the adjustment) – from a minimum of 5 patient contacts
o RIME – 5 assessments
• Written entrance examinations covering material presented during Orientation Week (Week 1) and the
Intern Manual. The breakdown of this grading is as follows:
A brief written exam will be given in Week 1 of the trimester. A re-exam will be offered again that
week. This written exam will serve as an “entrance exam” and the intern must successfully pass with
70% in order to be allowed to partake in patient care in Clinic Internship I.
• 50% of the grade in this course will be determined by participation. This will be measured, but not limited
to, the number of patients seen, active involvement in case round table discussions, and seminars. Another
perimeter of participation will depend upon how readily interns bring a clinician for observation at key
points during the course of patient care, especially as measured against the class as a whole. In addition,
there are a myriad of ways in which an intern can participate in the daily educational life of the clinic to their
and other team members’ betterment, and determination of this involvement is not limited to the few
examples noted above. Determination of participation is at the discretion of the faculty running the twiceweekly case discussions or observing an intern’s activities within this course in any clinic setting. Finally, a
determination of participation remains under the discretion of the department chair.
111 •
•
•
Interns will be expected to successfully complete the following:
o
Filing of lab results to include at least one each
o
CBC
o
UA
o
Comprehensive Metabolic profile
Individual assignments may be given by a duty clinician or by the department chair if in their judgment such
activity would be educational in nature.
10% of an intern’s grade is determined through assessment of the degree of professionalism, interpersonal
skills, ability to work under any of the clinicians assigned to oversee operations and instruction. Attitudinal
attributes such as enthusiasm, cooperativeness and efficiency all play a role in this determination. Factors
such as timeliness for shift, preparedness for the patient encounter, interactions with staff, interns and
clinicians are considered and are those interactions appropriate and commensurate with an intern’s status in
the clinic? Clinicians will be also looking for to what degree the intern displays independence? Are they
needy, complainers, or are they problem solvers and self-starters?
Failure to complete these requirements, attendance policy, intern conduct, as well as performance of Duty Intern
duties will be reflected on clinic evaluation forms.
Grading
Course grade is on a Pass/Fail basis. 70% is considered passing.
The College of Professional Studies’ policy regarding final examinations, as published in the most recent National
University of Health Sciences Bulletin, will be followed.
Missed Assessment(s):
o Missed entrance examination may be made up if the Chair of Clinical Practice has granted an excused
absence.
o The make-up examination must be made up within two weeks of the missed entrance examination unless the
Chair of Clinical Practice grants some special accommodation. Students will not be allowed to engage in
clinic activities until the examination is passed.
o Interns may be failed for lack of academic progress in the course, including failure to complete the entrance
examination in a timely manner, failure to engage in patient care, as well as failure to successfully
demonstrate competence in that care, and for other reasons outlined in the Intern Manual and other
University documents.
o Standard Process Field Trip to Palmyra, Wisconsin, is mandatory for the Illinois DC and ND students. Every
student is expected to attend this field trip with his class during his time in 8th trimester. Failure to attend
the field trip will require the student to make up the field trip with the next incoming 8th trimester class.
Review of Grades and Assessments:
As noted above, information concerning assessment will be collected through the use of ECQES. This data will be
reviewed and sent out as individual emails biweekly to each intern in the program. All other grades from quizzes,
midterms and the like will be posted on CygNET and/or available as an individual email sent to the intern’s current
account.
Each student has 10 calendar days from the date that a test or course grade is made available to review the grade.
Failure to discuss the grade or make an appointment to discuss the grade within that allotted time frame will result in
forfeiture of the right to question the grade. Questions regarding the course should be directed to Manuel Duarte,
DC, chair of clinical practice.
If the grades and assessments are below the passing grade but the intern has shown substantial participation in clinic
activities, it will be up to the discretion of the Chair of Clinical Practice to determine if the intern will receive an
incomplete versus a failure. If circumstances do come to this point, an exit exam may be administered. The intern
will be allowed one month from the last day of finals for the course to take this special exam. Prior to the
commencement of this one-month period, the intern will be required to outline a course of remediation, which will
be discussed and approved by the Chair.
112 The special examination to be administered will be generated by a committee composed of the Chair, the intern’s
clinician and another clinician. This same committee will also grade the finished exam separately, and then compare
their scores for the exam to ensure consistency. If there is a serious difference in the scoring of any given exam
question, the Dean of Clinics will provide the necessary determination for the final reconciled scoring.
During the period of this remediation and study the intern may attend their assigned outpatient clinic, but not
participate in patient care. If the intern successfully passes the special exit exam, all restrictions will be removed
from their activities in the outpatient setting. Failure to pass at 70% or above will ensure that the intern will repeat
Clinic Internship I.
Mentoring:
It is the natural and customary manner of such a clinical laboratory course that mentoring will be part of the daily
activities. Each member of the clinical staff will be available for consultation concerning the care of the student
patients and their family members under the interns’ care.
TEACHING METHODS AND ACTIVITIES:
Teaching methods within this clinician setting consist of oversight of patient care from the moment that the history
is obtained, guiding of which exams might be applicable, and development of the diagnosis and treatment plan
through to overseeing the actual care. In other words, a one-on-one encounter with the staff clinicians serving a
given shift is the principle method of instruction. There are opportunities for mentoring and small group tutorials,
especially pertaining to material presented in the case discussions, workshops and seminars connected with this
class.
COURSE OUTLINE (May be subject to change):
Course Outline: Will be given out during the first week of class (Orientation)
LABORATORY ATTIRE AND REQUIREMENTS:
The interns are expected to not only show up early for their shifts but also be properly attired for a clinical
environment. The details of what constitutes proper attire are clearly spelled out in the Intern Manual. It will be up
to the discretion of the duty clinician or Chair of Clinical Practice to make any judgment call in this realm. An intern
may be asked to leave the shift over this issue. The missed shift will be need to be made up within two weeks or will
count as an unexcused absence, which would need to be made up at a two-for-one ratio. Repeat offenses in this area
will be handled by the campus disciplinary committee.
PROFESSIONAL RESPONSIBILITY:
The College of Professional Studies' policy on code of conduct, as published in the most recent National University
of Health Sciences Student Handbook, will be followed.
ATTENDANCE POLICY:
Clinic attendance: If an intern knows in advance that they will miss a clinic assignment, 3 days notice should be given
to their clinician. Two excused absences are allowed during Clinic Internship I without being made up. Beyond that,
excused absence make-up shifts will be done on a one-to-one basis and should be scheduled and completed within
two weeks and upon approval of the make-up date by the department chair or a clinician. If illness or an unforeseen
event prevents attendance, interns should contact the clinic directly or by voice mail (630-889-6525) PRIOR to their
shift, or email their clinician and copy Dr. Duarte at: [email protected]. Non-reported missed shifts (or other
unexcused absences) will be made up on a two-for-one basis. Scheduled make-ups must be scheduled with at least 24
hours notice prior to presenting to the clinic. A maximum of two absences is allowed per trimester. Excess absences
must be approved by the Chair of Clinical Practice. There is no “banking” of absences in anticipation of time missed
from clinic without prior approval from the Chair of Clinical Practice.
Attendance at professional seminars does not constitute time spent in clinic nor an excused absence. Travel time to
and from a seminar or for National Boards is also considered an absence from the total of three “release days” an
intern is allowed.
113 An intern must be in the clinic and prepared for shift on time. If an intern is going to be late, they must contact their
clinician and inform them of the lateness. An intern who arrives 15 minutes late without notifying their clinician will
make up the shift on a two-to-one basis. If arriving less than 15 minutes late three times, the intern will be required to
make up the shift.
DISABILITY SUPPORT SERVICES:
Please refer to the most recently published National University of Health Sciences Student Handbook for further
information regarding disability disclosure and support services.
SYLLABUS INFORMATION:
Syllabus prepared by: Manuel Duarte, DC
Date: 31 December 2012
Modified 11 June, 2014, Drs. Duarte, Cohen
Curriculum Committee Approval Date:
NUHS President Approval Date:
Proposed changes to the course title and identification number, time requirement, prerequisites, general course
description, competencies, and objectives as described at the beginning of the syllabus, must be presented to the
appropriate department chair. The department chair, in conjunction with the assistant dean(s), may submit the
proposed changes to National University of Health Sciences Curriculum Committee. If approved, the curriculum
committee will submit the proposed changes to the president of National University of Health Sciences.
114 Appendix E
Clinic Internship II Syllabus
COURSE TITLE: Clinic Internship II
TIME REQUIREMENT: (hrs/week)
COURSE NUMBER: IC7100
Lecture: 0
Laboratory: 525
Total Clock Hours: 525
Course Credits: 17
PREREQUISITES: Successful completion of IC7000; American Heart Association BLS for Health Care
Professionals with AED CPR certification
COMPETENCIES GUIDING THE COURSE:
1. Medical Knowledge
2. Interpersonal and Communication Skills
3. Patient Care
4. Professionalism
5. Practice-based Learning and Improvement
6. Systems-based Practice
Given the particular needs of assessment within the clinical setting, some of these core competences are evaluated in
a targeted manner during the course of patient encounters. Below are listed the various areas where the Clinic
Internship I student must show an appropriate introductory level of mastery before being allowed to work without a
senior intern mentor. These are further described in Intern Manual Appendix A - CCE Standard H: Educational
Requirements for Doctor of Chiropractic Program
META-COMPETENCY 1 - ASSESSMENT & DIAGNOSIS
An assessment and diagnosis requires developed clinical reasoning skills. Clinical reasoning consists of data
gathering and interpretation, hypothesis generation and testing, and critical evaluation of diagnostic strategies. It is
a dynamic process that occurs before, during, and after the collection of data through history, physical
examination, imaging, and laboratory tests.
META-COMPETENCY 2 - MANAGEMENT PLAN
Management involves the development, implementation and documentation of a patient care plan for positively
impacting a patient’s health and well-being, including specific therapeutic goals and prognoses. It may include
case follow-up, referral, and/or collaborative care.
META-COMPETENCY 3 - HEALTH PROMOTION AND DISEASE PREVENTION
Health promotion and disease prevention requires an understanding and application of epidemiological principles
regarding the nature and identification of health issues in diverse populations and recognizes the impact of
biological, chemical, behavioral, structural, psychosocial and environmental factors on general health.
META-COMPETENCY 4 - COMMUNICATION AND RECORD KEEPING
Effective communication includes oral, written and nonverbal skills with appropriate sensitivity, clarity and
control for a wide range of healthcare related activities, to include patient care, professional communication, health
education, and record keeping and reporting.
META-COMPETENCY 5 - PROFESSIONAL ETHICS AND JURISPRUDENCE
Professionals comply with the law and exhibit ethical behavior.
115 META-COMPETENCY 6 - INFORMATION AND TECHNOLOGY LITERACY
Information and technology literacy are manifested in an ability to locate, evaluate and integrate research and other
types of evidence, including clinical experience, to explain and manage health-related issues and use emerging
technologies appropriately.
META-COMPETENCY 7 - INTELLECTUAL AND PROFESSIONAL DEVELOPMENT
Intellectual and professional development is characterized by maturing values and skills in clinical practice,
the seeking and application of new knowledge, and the ability to adapt to change.
GENERAL COURSE DESCRIPTION:
Students will further develop skills needed for successful management of patients and their conditions. Students will
participate in off-campus rotations to expand their experience and knowledge base. All students will be evaluated for
skill development, adjustive technique and case management. Students must provide a written case narrative on at
least 10 cases that they have managed or co-managed in the clinics. Students will participate in Quality Assurance
activities to ensure that the patient chart is in compliance with the University’s Quality Assurance program. Inservice training will be given in personnel issues for the practice, OSHA compliance issues for the private practice
office, provisional credentialing of the chiropractic intern, and Medicare issues for the private practice.
COURSE OBJECTIVES:
1. Demonstrate the basic to intermediate skills of patient care to the clinician on staff for your shift or clinic.
These skills are outlined in the course objectives in DC7043L.
2. Interact professionally with the clinician and upper trimester interns, focusing on primary care.
3. Design rehabilitation programs for a variety of physical ailments focusing on musculoskeletal conditions.
4. Have an increasing awareness of business procedures used in a successful practice.
5. Competently write referral letters, narrative reports, and requests to other health care professionals and
businesses related to the health care field.
6. Construct defensible replies to insurance denials utilizing EBP articles.
7. Generate 5 new patients to the clinic before graduation.
INSTRUCTOR INFORMATION AND OFFICE HOURS:
Regardless of the location of the clinic, Outpatient Clinical Internship is overseen by Manuel Duarte, DC, chair of
clinical practice. His office is located off the main clinic hallway overlooking the back outdoor courtyard, Room
311. Aside from when he has clinic shifts, generally he can be found in this office from 9:00 AM to 5:00 PM. The
extension for this office is 6525, although the best way to reach him is by email: [email protected]. It is strongly
suggested that if you wish to meet with him you make an appointment by email at least a week prior.
INSTRUCTIONAL MATERIALS:
Required Texts:
All previously utilized texts required for the previous clinical sciences courses will be considered required and will
be referred to on a regular basis.
Recommended/Supplemental Texts:
There are no recommended or supplemental texts.
Other Required/Recommended Instructional Materials:
In addition, the kit of diagnostic equipment given to students at the beginning of their career at National University
of Health Sciences should be with them every day. If they are found to be without these essential tools, they will
receive an unexcused absence for each day they are present without this gear.
EVALUATION OF STUDENT’S ACHIEVEMENT:
Compared to the rest of a student’s career at National, entrance into the clinic system, starting with Clinic Internship
I, marks a definitive change. Students are now responsible for the health and well-being of the patients under their
care. This is a simple but profound statement, underlying the added charge being laid upon the student. With this in
mind, the bar is set higher for passing in this setting.
116 Grading Procedure:
Course grade is Pass/Fail (70%).
Assessment will be based on:
• Evaluations generated for intern performance while in the clinic will be performed by the clinicians using
ECQES or a web browser based assessment tool (60% of the grade). The interns will need to be assessed by
the staff clinicians in the following categories over at least four different patients. It will be the student’s
responsibility to seek out a clinician to observe their activities in the following categories:
o History Taking – from 20 assessments
o Physical Exam Procedures – from 20 assessments
o Diagnosis – from 20 assessments
o Case Management – from 20 assessments
o Patient Education – from 20 assessments
o Manipulative Therapy (the adjustment) – from a minimum of 80 patient contacts
o RIME – 20 assessments (between 9th and 10th trimesters)
Special note: Interns must show a passing grade (70%) for each section noted above. If an intern falls below 70%,
they will be given an opportunity for remediation in the topic in question. Interns will be allowed two extra clinician
observed assessments to attempt to bring their grade up to a passing level. If an intern shows a score below 70% in
two or more categories, even after attempted remediation, they will be required to repeat the course. In addition the
intern may be asked to complete assignments for further educational need, as deemed necessary by clinician.
•
20% of an intern’s grade is determined through assessment of the degree of professionalism, interpersonal
skills, ability to work under any of the clinicians assigned to oversee operations and instruction. Attitudinal
attributes such as enthusiasm, cooperativeness and efficiency all play a role in this determination. Factors
such as timeliness for shift, preparedness for the patient encounter, interactions with staff, interns and
clinicians are considered, and are those interactions appropriate and commensurate with an intern’s status in
the clinic? Clinicians will be also looking for to what degree the intern displays independence? Are they
needy, complainers, or are they problem solvers and self-starters?
•
Given the unique nature of clinic, participation is critical to the learning process; therefore this aspect of the
clinical experience is given a high priority. 20% of the grade in this course will be determined by
participation. This will be measured, but not limited to, the number of patients seen, active involvement in
case discussions. Another perimeter of participation will depend upon how readily interns bring a clinician
for observation at key points during the course of patient care, especially as measured against the class as a
whole. In addition, there are a myriad of ways in which an intern can participate in the daily educational life
of the clinic to their and other team members’ betterment, and determination of this involvement is not
limited to the few examples noted above. Determination of participation is at the discretion of the clinician.
Finally, a determination of participation remains under the discretion of the department chair.
Failure to complete these requirements, attendance policy, intern conduct, as well as performance of DI duties may be
reflected on clinic evaluation forms.
Grading
As noted above, course grade is on a Pass/Fail basis. 70% is considered passing.
Special Note: Given that trimesters 8 through 10 make up the direct patient care clinical experience, there is a defined
set of requirements for graduation that need to be completed over the course of these trimesters. These requirements
are spelled out in detail in Appendix C of this document.
The College of Professional Studies’ policy regarding final examinations, as published in the most recent National
University of Health Sciences Bulletin, will be followed.
Missed Assessment(s):
o Missed final examinations may be made up if an excused absence has been granted by the appropriate dean.
o The make-up examination will be scheduled by the faculty member within two weeks of the missed final
117 examination but never later than the first day of class of the following trimester.
o If examinees are not present at the scheduled make-up exam time, they will receive the grade of F for the
course or lab unless the grade of I is reissued. Enrollment in any new courses will not be continued if
students have not converted the grade of I to a regular passing grade by the first calendar day of the second
calendar week of the next trimester of attendance. The removal of the I must be accomplished within the
maximum of one calendar year. Otherwise, the I becomes an F automatically.
The College of Professional Studies’ policy regarding make-up final examinations, as published in the most recent
National University of Health Sciences Bulletin, will be followed.
Review of Grades and Assessments:
As noted above, information concerning assessment will be collected through the use of ECQES or an Internet
browser based database system and updated by the clinician(s). This data will be reviewed and sent out as individual
emails biweekly to each intern in the program.
Each student has 10 calendar days from the date that a test or course grade is made available to review the grade.
Failure to discuss the grade or make an appointment to discuss the grade within that allotted time frame will result in
forfeiture of the right to question the grade. Questions regarding the course should be directed to Manuel Duarte,
DC, chair of clinical practice.
Mentoring:
It is the natural and customary manner of such a clinical laboratory course that mentoring will be part of the daily
activities. Each member of the clinical staff will be available for consultation concerning the care of the student
patients and their family members under the interns care.
TEACHING METHODS AND ACTIVITIES:
Teaching methods within this clinician setting consist of oversight of patient care from the moment that the history
is obtained, guiding of which exams might be applicable, and development of the diagnosis and treatment plan
through to overseeing the actual care. In other words, one-on-one encounters with the staff clinicians serving a given
shift are the principle method of instruction. There are opportunities for mentoring and small group tutorials,
especially pertaining to material presented in the seminars connected with this class.
ADDITIONAL COURSE CONTENT:
There is no additional course content.
LABORATORY ATTIRE AND REQUIREMENTS:
The interns are expected to not only show up early for their shifts but also be properly attired for a clinical
environment. The details of what constitutes proper attire is clearly spelled out in the Clinic Intern Manual. It will be
up to the discretion of the duty clinician to make any judgment call in this realm. Repeat offenses in this area will be
handled by the campus disciplinary committee.
PROFESSIONAL RESPONSIBILITY:
The College of Professional Studies’ policy on code of conduct, as published in the most recent National University
of Health Science Student Handbook, will be followed.
ATTENDANCE POLICY:
Attendance at in-services or seminars is mandatory. Roll is taken by the clinician to whom the intern has been
assigned, with the window for not receiving a tardy closed out 10 minutes after the clinic shift starts. Two tardies will
constitute an absence. If the intern has a patient scheduled and they are not there prior to the patient’s arrival, they
will receive a tardy and no credit for their activities in the clinic that shift. If the intern totally misses the appointment
through non-attendance and the case must be passed to another intern, this is not only an absence but they will be
suspended from receiving credit for patient care for a week.
Clinic attendance: If an intern knows in advance that they will miss a clinic assignment, 3 days notice should be
given to their clinician. Make-up shifts will be done on a one-to-one basis and should be scheduled within a week. If
illness or an unforeseen event prevents attendance, interns should contact their clinician directly or by voice mail
118 PRIOR to their shift. Non-reported missed shifts will be made up on a two-for-one basis. Scheduled make-ups must
be scheduled with at least 24 hours notice prior to presenting to the clinic. A maximum of three absences is allowed
per trimester. Excess absences must be approved by the Chair of Clinical Practice and will be made in consultation by
the clinician overseeing the intern. If deemed appropriate, absences in excess of the three allowed will be made up
shift-for-shift at a two-to-one ratio after notification of completion (“pink slips”) of requirements for graduation have
been given out at the end of Trimester 10. Release of an intern’s diploma will be held back until these shifts have
been completed. There is no “banking” of absences in anticipation of time missed from clinic without prior approval
from the chair of clinical practice.
Interns are expected to show up early for their shifts for patients will be present from the moment the shift starts. An
intern must be in the clinic and prepared for their shift on time. If an intern is going to be late, they must contact their
clinician and inform them of the lateness. An intern who arrives 20 minutes late without notifying their clinician will
make up the shift on a two-for-one basis. If arriving less than 20 minutes late three times, the intern will be required
to make up the shift.
Attendance at off-campus professional seminars does not constitute time spent in clinic nor an excused absence.
Travel time to and from a seminar or the National Boards also falls into the same category.
DISABILITY SUPPORT SERVICES:
Please refer to the most recently published National University of Health Sciences Student Handbook for further
information regarding disability disclosure and support services.
SYLLABUS INFORMATION:
Syllabus prepared by: Manuel Duarte, DC
Date: 31 December 2012
Curriculum Committee Approval Date:
NUHS President Approval Date:
Proposed changes to the course title and identification number, time requirement, prerequisites, general course
description, competencies, and objectives as described at the beginning of the syllabus, must be presented to the
appropriate department chair. The department chair, in conjunction with the assistant dean(s), may submit the
proposed changes to National University of Health Sciences’ Curriculum Committee. If approved, the curriculum
committee will submit the proposed changes to the president of National University of Health Sciences.
119 120 Appendix F
Clinic Internship III Syllabus
COURSE TITLE: Clinic Internship III
TIME REQUIREMENT: (hrs/week)
COURSE NUMBER: IC7200
Lecture: 0
Laboratory: 525
Total Clock Hours: 525
Course Credits: 17
PREREQUISITES: Successful completion of IC7100, American Heart Association BLS for Health Care
Professionals with AED CPR certification.
COMPETENCIES GUIDING THE COURSE:
1. Medical Knowledge
2. Interpersonal and Communication Skills
3. Patient Care
4. Professionalism
5. Practice-based Learning and Improvement
6. Systems-based Practice
Given the particular needs of assessment within the clinical setting, some of these core competences are evaluated in
a targeted manner during the course of patient encounters. Below are listed the various areas where the Clinic
Internship I student must show an appropriate introductory level of mastery before being allowed to work without a
senior intern mentor. These are further described in Intern Manual Appendix A - CCE Standard H: Educational
Requirements for Doctor of Chiropractic Program
META-COMPETENCY 1 - ASSESSMENT & DIAGNOSIS
An assessment and diagnosis requires developed clinical reasoning skills. Clinical reasoning consists of data
gathering and interpretation, hypothesis generation and testing, and critical evaluation of diagnostic strategies. It is
a dynamic process that occurs before, during, and after the collection of data through history, physical
examination, imaging, and laboratory tests.
META-COMPETENCY 2 - MANAGEMENT PLAN
Management involves the development, implementation and documentation of a patient care plan for positively
impacting a patient’s health and well-being, including specific therapeutic goals and prognoses. It may include
case follow-up, referral, and/or collaborative care.
META-COMPETENCY 3 - HEALTH PROMOTION AND DISEASE PREVENTION
Health promotion and disease prevention requires an understanding and application of epidemiological principles
regarding the nature and identification of health issues in diverse populations and recognizes the impact of
biological, chemical, behavioral, structural, psychosocial and environmental factors on general health.
META-COMPETENCY 4 - COMMUNICATION AND RECORD KEEPING
Effective communication includes oral, written and nonverbal skills with appropriate sensitivity, clarity and
control for a wide range of healthcare related activities, to include patient care, professional communication, health
education, and record keeping and reporting.
META-COMPETENCY 5 - PROFESSIONAL ETHICS AND JURISPRUDENCE
Professionals comply with the law and exhibit ethical behavior.
121 META-COMPETENCY 6 - INFORMATION AND TECHNOLOGY LITERACY
Information and technology literacy are manifested in an ability to locate, evaluate and integrate research and other
types of evidence, including clinical experience, to explain and manage health-related issues and use emerging
technologies appropriately.
META-COMPETENCY 7 - INTELLECTUAL AND PROFESSIONAL DEVELOPMENT
Intellectual and professional development is characterized by maturing values and skills in clinical practice,
the seeking and application of new knowledge, and the ability to adapt to change.
GENERAL COURSE DESCRIPTION:
Students enter the senior intern phase of training when skill development and evaluation continues until graduation.
Students will participate in the development of junior interns and begin advanced technique electives. Students will
explore off-campus observations and assignments to expand their knowledge base and obtain exposure to private
practice via mentoring with a licensed field doctor. In-service training will consist of advanced diagnostic
procedures such as EMG, MRI, ultrasonography, etc. There will be a continuation of rehabilitation training and
advanced treatment techniques to help refine the skill levels of the intern prior to graduation. Business office
rotations and insurance submission experience is offered.
COURSE OBJECTIVES:
At the end of this course the student will be able to:
1. Demonstrate the basic skills of patient care to a junior intern. These skills are outlined in the course
objectives in DC7043L.
2. Interact professionally with chiropractic field doctors as well as other specialties focusing on primary
care.
3. Design comprehensive rehabilitation programs for a variety of physical ailments focusing on
musculoskeletal conditions.
4. Assess the appropriateness of business procedures in a successful practice.
5. Complete third party payment criteria for a spectrum of primary care conditions.
6. Competently write referral letters, narrative reports, and requests to other health care professionals and
businesses related to the health care field.
7. Construct defensible replies to insurance denials utilizing EBP articles.
8. Each intern is required to generate 5 new patients to the clinic before graduation.
INSTRUCTOR INFORMATION AND OFFICE HOURS:
Instruction and mentoring is provided to the intern by the clinician who is on staff or covering the clinic on a given
day or shift. Their office hours generally will be the hours that the clinic is open. Regardless of the location of the
clinic, Outpatient Clinical Internship is overseen by Manuel Duarte, DC, chair of clinical practice. His office is
located off the main clinic hallway overlooking the back outdoor courtyard, Room 311. Aside from when he has
clinic shifts, generally he can be found in this office from 9:00 a.m. to 5:00 p.m. The extension for this office is
6525, although the best way to reach him is by email: [email protected]. It is strongly suggested that if you wish to
meet with him you make an appointment by email at least a week prior.
INSTRUCTIONAL MATERIALS:
Required Texts:
All previously utilized texts required for the previous clinical sciences courses will be considered required and will
be referred to on a regular basis
Recommended/Supplemental Texts:
There are no recommended or supplemental texts.
Other Required/Recommended Instructional Materials:
In addition, the kit of diagnostic equipment given to students at the beginning of their career at National University
of Health Sciences should be with them every day. If they are found to be without these essential tools, they will
receive an unexcused absence for each day they are present without this gear.
122 EVALUATION OF STUDENT'S ACHIEVEMENT:
Compared to the rest of a student’s career at National, entrance into the clinic system, starting with Clinic Internship
I, marks a definitive change. Students are now responsible for the health and well-being of the patients under their
care. This is a simple but profound statement, underlying the added charge being laid upon the student. With this in
mind, the bar is set higher for passing in this setting.
Grading Procedure:
Course grade is Pass/Fail (70%).
Assessment will be based on:
• Evaluations generated for intern performance while in the clinic will be performed by the clinicians using
ECQES or a web browser based assessment tool. (60% of the grade). The interns will need to be assessed by
the staff clinicians in the following categories over at least four different patients. It will be your
responsibility to seek out a clinician to observe your activities in the following categories:
o History Taking – from 20 assessments Physical Exam Procedures – from 20 assessments
o Diagnosis – from 20 assessments
o Case Management – from 20 assessments
o Patient Education – from 20 assessments
o Manipulative Therapy (the adjustment) – from a minimum of 80 patient contacts
o RIME – 20 assessments (between 9th and 10th trimesters)
Special note: You must show a passing grade (70%) for each section noted above. If you fall below 70% you will be
given an opportunity for remediation in the topic in question. You will be allowed two extra clinician observed
assessments to attempt to bring your grade up to a passing level. If the intern shows a score below 70% in two or
more categories, even after attempted remediation, they will be required to repeat the course. In addition the intern
may be asked to complete assignments for further educational need, as deemed necessary by the clinician.
•
20% of an intern’s grade is determined through assessment of the degree of professionalism, interpersonal
skills, ability to work under any of the clinicians assigned to oversee operations and instruction. Attitudinal
attributes such as enthusiasm, cooperativeness and efficiency all play a role in this determination. Factors
such as timeliness for shift, preparedness for the patient encounter, interactions with staff, interns and
clinicians are considered, and are those interactions appropriate and commensurate with an intern’s status in
the clinic? Clinicians will be also looking for to what degree the intern displays independence? Are they
needy, complainers, or are they problem solvers and self-starters?
•
Given the unique nature of clinic, participation is critical to the learning process, therefore this aspect of the
clinical experience is given a high priority. 20% of the grade in this course will be determined by
participation. This will be measured, but not limited to, the number of patients seen, active involvement in
case discussions. Another perimeter of participation will depend upon how readily interns bring a clinician
for observation at key points during the course of patient care, especially as measured against the class as a
whole. In addition, there are a myriad number of ways in which an intern can participate in the daily
educational life of the clinic to their and other team members’ betterment, and determination of this
involvement is not limited to the few examples noted above. Determination of participation is at the
discretion of the clinician. Finally, a determination of participation remains under the discretion of the
department chair.
Failure to complete these requirements, attendance policy, intern conduct, as well as performance of DI duties may be
reflected on clinic evaluation forms.
Grading
As noted above, course grade is on a Pass/Fail basis. 70% is considered passing.
Special Note: Given that trimesters 8 through 10 make up the direct patient care clinical experience, there is a defined
set of requirements that need to be completed over the course of these semesters required for graduation. These
requirements are spelled out in detail in Appendix C in this document.
123 The College of Professional Studies’ policy regarding final examinations, as published in the most recent National
University of Health Sciences Bulletin, will be followed.
Missed Assessment(s):
Since this is a clinical course, based upon direct patient care, the issue of missed assessments will not arise. This is
especially true given that there are not written examinations associated with this course.
Review of Grades and Assessments:
As noted above, information concerning assessment will be collected through the use of PDAs or an Internet
browser based database system and updated by the clinician(s). This data will be reviewed and sent out as individual
emails biweekly to each intern in the program.
Each student has 10 calendar days from the date that a test or course grade is made available to review the grade.
Failure to discuss the grade or make an appointment to discuss the grade within that allotted time frame will result in
forfeiture of the right to question the grade. Questions regarding the course should be directed to Manuel Duarte,
DC, chair of clinical practice.
Mentoring:
It is the natural and customary manner of such a clinical laboratory course that mentoring will be part of the daily
activities. Each member of the clinical staff will be available for consultation concerning the care of the student
patients and their family members under the interns’ care.
TEACHING METHODS AND ACTIVITIES:
Teaching methods within this clinician setting consists of oversight of patient care from the moment that the history
is obtained, guiding of which exams might be applicable, and development of the diagnosis and treatment plan
through to overseeing the actual care. In other words, one-on-one encounters with the staff clinicians serving a given
shift are the principle method of instruction. There are opportunities for mentoring and small group tutorials,
especially pertaining to material presented in the seminars connected with this class.
ADDITIONAL COURSE CONTENT:
There is no additional course content.
LABORATORY ATTIRE AND REQUIREMENTS:
The interns are expected to not only show up early for their shifts but also be properly attired for a clinical
environment. The details of what constitutes proper attire is clearly spell out in the Clinic Intern Manual. It will be
up to the discretion of the duty clinician to make any judgment call in this realm. Repeat offenses in this area will be
handled by the campus disciplinary committee.
PROFESSIONAL RESPONSIBILITY:
The College of Professional Studies’ policy on code of conduct, as published in the most recent National University
of Health Sciences Student Handbook, will be followed.
ATTENDANCE POLICY:
Attendance at in-services or seminars is mandatory. Roll is taken in the form of a sign-in sheet in the clinic lounge,
with the window for not receiving a tardy closed out 15 minutes after the clinic shift starts. Two tardies will constitute
an absence. If the intern has a patient scheduled and they are not there prior to the patient’s arrival they will receive a
tardy and no credit for their activities in the clinic that shift. If the intern totally misses the appointment through nonattendance and the case must be passed to another intern, this is not only an absence but they will be suspended from
receiving credit for patient care for a week.
Seminar attendance is handled by roll call at the beginning of a given session. An excuse is given for tardiness when
patient care comes first, but only upon the approval of the duty clinician. Interns will still be responsible for the
content of the seminar or workshop. Like attendance in clinic, interns are allowed up to four absences from seminar.
Clinic attendance: If an intern knows in advance that they will miss a clinic assignment, 3 days notice should be given
to their clinician. Make-up shifts will be done on a one-to-one basis and should be scheduled within a week. If illness
124 or an unforeseen event prevents attendance, interns should contact their clinician directly or by voice mail PRIOR to
their shift. Non-reported missed shifts will be made up on a two-to-one basis. Scheduled make-ups must be scheduled
with at least 24 hours notice prior to presenting to the clinic. A maximum of three absences is allowed per trimester.
Excess absences must be approved by the Chair of Clinical Practice and will be made in consultation by the clinician
overseeing the intern. If deemed appropriate, absences in excess of the three allowed will be made up shift-for-shift at
a two-to-one ratio after notification of completion (“pink slips”) of requirements for graduation have been given out
at the end of Trimester 10. Release of an intern’s diploma will be held back until these shifts have been completed.
There is no “banking” of absences in anticipation of time missed from clinic without prior approval from the chair of
clinical practice.
Interns are expected to show up early for their shifts for patients will be present from the moment the shift starts. An
intern must be in the clinic and prepared for their shift on time. If an intern is going to be late, they must contact their
clinician and inform them of the lateness. An intern who arrives 20 minutes late without notifying their clinician will
make up the shift on a two-to-one basis. If arriving less than 20 minutes late three times, the intern will be required to
make up the shift.
Attendance at off-campus professional seminars does not constitute time spent in clinic nor an excused absence.
Travel time to and from a seminar or the National Boards also falls into the same category.
DISABILITY SUPPORT SERVICES:
Please refer to the most recently published National University of Health Sciences Student Handbook for further
information regarding disability disclosure and support services.
SYLLABUS INFORMATION:
Syllabus prepared by: Manuel Duarte, DC
Date: 17 December 2012
Curriculum Committee Approval Date:
NUHS President Approval Date:
Proposed changes to the course title and identification number, time requirement, prerequisites, general course
description, competencies, and objectives as described at the beginning of the syllabus, must be presented to the
appropriate department chair. The department chair, in conjunction with the assistant dean(s), may submit the
proposed changes to National University of Health Sciences’ Curriculum Committee. If approved, the curriculum
committee will submit the proposed changes to the president of National University of Health Sciences.
125 126 Appendix G
Abbreviations
Abbreviations
A
a.c.
ad feb.
ad int.
ad lib.
BCP
b.i.d.
BM
Before
Before Meals
Fever Present
In the interim
As Wanted
Birth Control Pill
Twice per day
Bowel Movement
n/1
n.p.o.
OB/GYN
OC
OTC
p
p
PERLA
BP
Bx
C
CA
CBC
CBR
CMT
COPD
CP
CVA
CVP
D/C
DD
Dx
ECG or EKG
EEG
HEENT or EENT
EMS
ESR
FBC/FBS
FUO
FX
GI
GU
HA
Hb or HgB
Hct
HMP
HTN
HVG
Hx
IF or FC
IUD
JVP
LLQ
LUQ
MCB
MI
MVA
Blood pressure
Biopsy
With
Cancer
Complete Blood Count
Complete Bed Rest
Chiropractic Manipulative Therapy
Chronic Obstructive Pulmonary Disease
Cold Packs
Cerebrovascular Accident
Central Venous Pressure
Discontinue
Differential Diagnosis
Diagnosis
Electrocardiogram
Electroencephalogram
Head/Eyes/Ears/Nose/Throat
Electrical Muscle Stimulation
Erythrocyte Sedimentation Rate
Fasting Blood Glucose/Sugar
Fever of Unknown Origin
Fracture
Gastrointestinal
Genitourinary
Headache
Hemoglobin
Hematocrit
Hot Moist Packs
Hypertension
High Volt Galvanism
History
Interferential Therapy
Intrauterine Device
Jugular Venous Pressure
Left Lower Quadrant
Left Upper Quadrant
Mean Corpuscular Volume
Myocardial Infarction
Motor Vehicle Accident
pt.
Pt Ed.
PT
Pap
p.c.
PMI
p.r.n.
PVC
Px
q.a.m.
q.d.
q.h.
q.i.d.
q.o.d.
q.p.m.
R
R/O
RLQ
ROM
RUQ
Rx
s
SOB
Stat.
STM
SWD
Sx
Sy
T
t.i.d.
TPT
tx
T.O.
Tx
U/A
URI
US
UTI
WNL
127 Normal Limits
Nothing by Mouth
Obstetrics and Gynecology
Oral Contraceptive
Over the Counter
After
Pulse
Pupils Equally Reactive to Light and
Accommodation
Patient
Patient Education
Physical Therapy
Papanicolaou Smear
After Meals
Point of Maximum Intensity
As Needed
Premature Ventricular Contraction
Physical Exam
Every Morning
Every Day
Every Hour
Four Times Per Day
Every Other Day
Every Afternoon/Evening
Respirations
Rule Out
Right Lower Quadrant
Range of Motion
Right Upper Quadrant
Therapy/prescription
Without
Shortness of Breath
Immediately
Soft Tissue Massage
Shortwave Diathermy
Surgery
Symptoms
Temperature
Three Times Per Day
Trigger Point Therapy
Traction
Telephone Order
Treatment
Urinalysis
Upper Respiratory Infection
Ultrasound
Urinary Tract Infection
Within Normal Limits
128 Appendix H
DC Intern Weekly Tally Sheet
129 130 Appendix I
Equipment Damage and Repair Form
131 132 Appendix J
Clinic Outreach Record
133 134 Appendix K
Clinic Community Outreach Hours Form
135 136 Appendix L
Accident / Incident Report
Accident / Incident Report Form
FOR A CLINIC ACCIDENT / INCIDENT, IMMEDIATELY SEND THIS
REPORT TO HUMAN RESOURCES AND SEND A COPY TO THE
DEAN OF CLINICS.
This is an
! Accident Report
! Incident Report
Date of Report
Employee
!
Student
!
Student Emp.
!
Athlete
!
Visitor
!
Patient
!
Time Reported
a.m. / p.m.
Person Involved
Home Phone
Social Security #
Address
Street
!
Male
City
!
Female
!
Single
State
!
Married
Department
Title
Date
Time
!
Zip Code
Divorced
!
Widowed
a.m. / p.m.
Location
What Happened
Individual in Charge
Administrative Information
Person in charge when accident/incident occurred
Staff member(s) witnessing accident
Names and addresses of other witnesses
Treatment
Recommendation
Sent to
Doctor/Hospital
By whom
Who was notified?
! Ambulance
! Security
! Police
Describe any other actions
Your Signature
Date
Use Back of Sheet for Other Information
137 Revised - 12/12/2011
138 Appendix M
Supervisor’s Accident / Incident Report
!
This is an
Supervisor’s Accident/Incident Report
☐ Accident Report
☐ Incident Report
Date of Accident/Incident_________________ Time of Accident/Incident____________
a.m./p.m.
Personnel in Charge_____________________________________________________
Person Involved_________________________________________________________
Location_______________________________________________________________
Description of Accident/Incident____________________________________________
Interventions Taken______________________________________________________
Outcome of Interventions__________________________________________________
Was Emergency Personnel Notified?________________________________________
Was Emergency Transport Needed?________________________________________
Is Follow-up Needed?______________ If so, when?____________________________
By whom?_____________________________________________
Supervisor’s Signature_______________________________ Date ________________
Created'08/07/2013'
139 140 Appendix N
Clinical Clerkship Qualifications & Application Requirements
Clinical Clerkship Qualifications
and Application Requirements
To Quality you must have the following prerequisites:
• Grade Point Average of at least 2.75 or better
• Currently in or starting the correct Trimester depending on Clinic’s requirements and stated within the body of information on each clinic
To Apply:
Filled out 4 page application form – Application forms are obtained from Jean Fairbank, Student Coordinator. Can only request
application in person from Jean her office is on the second floor of the clinic room 533.
Mandatory documents that need to be supplied along with application form are:
• Copies of all Immunization records
• Current yearly TB test results
• Proof of HEP B, 3 shot series
• Current Curriculum Vitae
• Copy of your most recent NBCE exam scores letter
• Official NUHS transcripts must be sent directly to the Dean of Clinics in an envelope sealed by the registrar
• Letter to Clerkship Program titled: “Why I would be a good Candidate for the Clerkship”
ADDED PREREQUISITES FOR BETHESDA CLERKSHIP
• Must be a U.S. Citizen
• More extensive background check – DOCUMENTS SUBMITTED 40 DAYS IN ADVANCE
• All trainees will complete the SAAR-N upon arrival to NNMC
NNMC SECURITY PROCEDURES
Trainees Rotating at NNMC over 30 days:
The NNMC Clinical Champion (or GME Office if a clinical champion is not identified) will send Standard Forms 85P and 306 to the
trainees. Trainees must submit completed these two forms with a fingerprint card to the Clinical Champion 30 Days prior to the first
day of training. The three forms (SF85P, SF306, and finger print card) will be forwarded to the command security manager.
At least two weeks prior to the start of training, each trainee must submit a Base Access Form to the clinical champion. This form will
be forwarded to the Pass and ID office.
Location:
Bethesda - National Naval Medical Center (NNMC)
8901 Wisconsin Avenue
Bethesda MD 20889
Dr. Bill Morgan
Availability:
1 Student
Length of Program:
6 Months – January and June
Apply:
Beginning of 9th and or 10th Trimester
Housing:
Not provided – must find own housing
Note:
Open to other college applications
141 Two Sided
http://clinicalinfo.nuhs.edu
Location:
Veterans Administration
1900 E Main
Danville, IL 61832
Dr. Don Owens
Availability:
1 Student
Length of Program:
1 Month
Apply:
End of 8th Trimester to Beginning of 9th Trimester
Application Deadline:
No later than the fourth Friday of Trimester 9
Housing:
Provided
Note:
We are the only college who applies
Location:
Cancer Treatment Centers of America (CTCA)
Midwestern Regional Medical Center Inc.
2520 Elisha Ave.
Zion, IL 60099
Dr. Jim Rosenburg
Availability:
1 Student
Length of Program:
1 Month
Apply:
Beginning of 9th or 10th Trimester
Application Deadline:
No later than the fourth Friday of Trimester 9
Housing:
Not provided – must find own housing
ON HOLD UNTIL 2016 DUE TO A RESEARCH PROJECT
Location:
Naval Air Station – Clinic- Pensacola
6000 W. Hwy 98
Pensacola, Fl 32512
Dr. Greg Lillie
Availability:
1 Student
Length of Program:
6 Months – January and June
Apply:
Beginning of 9th or 10th Trimester
Application Deadline:
No later than the fourth Friday of Trimester 9
Housing:
Not provided – Must find own housing
Note:
Open to other college applications – at this time
142 Appendix O
Ancillary Clinical Experience (ACE) Basics
NUHS – Clinical Clerkship Program (CCP)
Ancillary Clinical Experience (ACE) Basics
National University of Health Sciences (NUHS) Ancillary Clinical Experience (ACE) is designed to offer senior chiropractic/naturopathic
interns the opportunity to gain valuable clinical experience in a private practice setting under the close supervision and
guidance of an experienced, ethical and successful physician (adjunct faculty physician).
The program functions within the parameters established by the Council on Chiropractic Education (CCE) for DC interns and
the parameters established by the Council on Naturopathic Medical Education (CNME) for ND interns, as well as the state
licensing board of the respective state in which the adjunct faculty clinician is located.
The program allows eligible interns to spend part of their clinical training in an off-campus educational experience. The
supervising practitioners are adjunct faculty clinicians of National University of Health Sciences.
CLINICAL CLERKSHIP PROGRAM ORGANIZATION
AND THE CLINICAL CLERKSHIP PROGRAM COMMITTEE
The Clinical Clerkship Program (CCP) is under the authority of the Dean of Clinics. The Dean of Clinics oversees the activities
of the CCP and has the day-to-day responsibility for the program. The CCP Committee, chaired by the Dean of Clinics, is
responsible for reviewing applications from interns and preceptors, making recommendations to the Dean of Clinics regarding
program participants, reviewing the progress and performance of participants, and advising the Dean of Clinics on matters
concerning the operation and effectiveness of the program. The Dean of Clinics submits recommendations to the Vice
President for Academic Services and final approval of the preceptor must be obtained from the President or his/her designee.
The Dean of Clinics, in conjunction with his/her chosen advisors, will determine the number of interns assigned to a CCP. Each
clinician at the University clinics, with the exception of those at the Salvation Army Clinics, must have a minimum of 5 interns
per shift. If this number is not met, then the CCP request may not be approved.
INTERN QUALIFICATIONS – ACE
To be eligible for selection for participation in the ACE, an intern must meet the following criteria:
1. Successful completion of Phase 3, Term 1 (9th trimester) internship of DC/ND programs.
2. Successful completion of all of the University’s academic and clinical requirements for graduation,
except for the required number of internship clock hours.
3. Be in good academic standing and making satisfactory academic progress. A 2.75 GPA average is required.
4. Recommended for participation by the supervising attending clinician and the Chair of Clinical Practice
(and the Assistant Dean of Naturopathic Medicine – ND interns only).
5. Passed Part I and II of the examinations of the NBCE. (DC Interns only)
6. Must not be the subject of any University or clinic disciplinary action.
7. Completed all assigned patient care records and related forms including narratives and insurance forms
to the satisfaction of the supervising attending clinician.
8. Submitted a completed application form to the Vice President for Administrative Services accompanied
by a current curriculum vita.
9. Agree, as evidenced by a signed affidavit, to abide by the law(s) governing adjunct faculty clinicians in the
jurisdiction in which the applicant seeks to participate and to abide by the provisions of the NUHS CCP.
http://clinicalinfo.nuhs.edu
143 144 Appendix P
Clinical Based Internship (CBI) Basics
NUHS – Clinical Clerkship Program (CCP)
Clinical Based Internship (CBI) Basics
National University of Health Sciences (NUHS) is designed to offer chiropractic interns the opportunity to gain valuable clinical
experience in a private practice setting under the close supervision and guidance of an experienced, ethical and successful adjunct
faculty clinician.
The program functions within the parameters established by the Council on Chiropractic Education (CCE) for DC interns, as well as
the state licensing board of the respective state in which the adjunct faculty clinician is located.
The program allows eligible interns to spend part of their clinical training in an off-campus educational experience. The
supervising practitioners are adjunct faculty clinicians of National University of Health Sciences.
CLINICAL CLERKSHIP PROGRAM ORGANIZATION
AND THE CLINICAL CLERKSHIP PROGRAM COMMITTEE
The Clinical Clerkship Program (CCP) is under the authority of the Dean of Clinics. The Dean of Clinics oversees the activities
of the CCP and has the day-to-day responsibility for the program. The CCP Committee, chaired by the Dean of Clinics, is
responsible for reviewing applications from interns and preceptors, making recommendations to the Dean of Clinics regarding
program participants, reviewing the progress and performance of participants, and advising the Dean of Clinics on matters
concerning the operation and effectiveness of the program. The Dean of Clinics submits recommendations to the Vice
President for Academic Services and final approval of the preceptor must be obtained from the President or his/her designee.
The Dean of Clinics, in conjunction with his/her chosen advisors, will determine the number of interns assigned to a CCP. Each
clinician, with the exception of those at the Salvation Army Clinics, must have a minimum of 5 interns per shift. If this number
is not met, then the CCP request may not be approved.
INTERN QUALIFICATIONS – CBI
To be eligible for selection for participation in the CBI, an intern must meet the following criteria:
1. Successful completion of the didactic components of the first professional program.
2. Be in good academic standing and making satisfactory academic progress.
A 2.75 GPA average is required.
3. Recommended for participation by the supervising attending clinician and the Chair
of Clinical Practice.
4. Passed Part I and II of the examinations of the NBCE.
5. Must not be the subject of any University or clinic disciplinary action.
6. Completed all assigned patient care records and related forms including narratives and
insurance forms to the satisfaction of the supervising attending clinician.
7. Submitted a completed application form to the Vice President for Administrative Services
accompanied by a current curriculum vita.
8. Agree, as evidenced by a signed affidavit, to abide by the law(s) governing adjunct faculty
clinicians in the jurisdiction in which the applicant seeks to participate and to abide by the
provisions of the NUHS CCP.
http://clinicalinfo.nuhs.edu
145 146 Appendix Q
Request for Independent Clinic Observation
REQUEST FOR INDEPENDENT CLINIC OBSERVATION
Date of Request _________________
Current Trimester (Circle)
Intern Name ______________________
Clinician _____________________
9 10
I wish to request time off from my regular clinic shift in order to observe at the clinic
listed below. I understand that I am at no time authorized to render any form of care to
any patient during this observation.
Doctor’s Name ____________________________________________________________
Clinic Name: ______________________________________________________________
Address:__________________________________________________________________
Phone #: _________________________ Dates of Observation:_____________________
Hours student will be at Doctor’s Office: ________________________________________
Intern’s Signature: ________________________ Total # of Hrs. at Doctor’s: ___________
Cell Number: __________________________
Date: ____________________________
DOCTOR’S ACKNOWLEDGMENT
Signature below indicates that the above-named doctor acknowledges this request and agrees
to accept the student, on an observation only basis for the date(s) and hours listed above.
Approval of this observation shall no way imply a relationship between the doctor and
National University of Health Sciences. The doctor is not to be considered as faculty of the
University and therefore is prohibited from allowing the observing student to render any form
of health care on his/her patients.
Doctor’s Signature _______________________________________________
A copy of your Doctor’s License must be attached to this form.
Please print name _______________________________________________
APPROVAL OF OBSERVATION
Clinician’s Signature__________________________________
Date_______________
Dean of Clinic’s Signature_____________________________
Date________________
Clinic Services Mgr. _______________________ Verified Requirements are met
Observations may be for a maximum of 10 days total (with no "renewal" of the 10 days
allowed) and the student needs to be done with his/her numbers before an observation.)
The observation in no way constitutes or serves as a prelude to a preceptorship
agreement. Paperwork deadline: paperwork must be completed no later than the
third Thursday prior to graduation date.
Revised: 7/28/14
147 148 SIGNATURE PAGE
NATIONAL UNIVERSITY OF HEALTH SCIENCES
NON-SOLICITATION OF PATIENTS AGREEMENT
Student Intern (Print Name) ___________________________________
The parties agree that the treatment of patients/clients is a valuable and integral part of the
University’s operation and that the University has spent valuable time, effort and expense in
securing patients/clients and in developing and maintaining data, records, information and
services associated with same. Therefore, during the term of this Clinical Rotation Agreement
and for a period of two years following graduation from the University, the Student shall not,
either directly or indirectly, perform any act or make any statement which would tend to divert
any current patients/clients away from the University or solicit any current patients/clients of any
University Clinic, wherever located, either for him/herself for any other person, firm, corporation
or health care practice without prior permission, in writing, from the Dean of Clinics or his
designee.
This shall not limit the intern (with clinician approval) in the clinics from making appropriate
and documented patient referrals for diagnostic or therapeutic care. A current patient/client is any
individual who, during the clinical enrollment or the year immediately prior to the effective date
of this Clinical Rotation contract, visited any University Clinic for the purpose of receiving
health care, counsel or treatment. In the event that a Student violates this provision, said violation
will be cause for immediate action up to and including expulsion.
________________________________________________________
Signature of Intern
________________________________________________________
Date (mm/dd/yyyy)
This form must be on file with the office of the Dean of Clinics before you may see clients in the clinics. Please make a copy for yourself.
149 150 SIGNATURE PAGE
I, _____________________________________ acknowledge that I have read and understand
the contents of the National University of Health Sciences’ Clinic Intern Manual for the class
entering clinic in the _________________________ Trimester.
I further acknowledge that I will respect and follow any modifications made and communicated
to me by the office of the Dean of Clinics including any updated revisions of the Clinic Intern
Manual or sections thereof. I recognize and will respect the University ownership of property,
equipment and client related information with which I may come in contact during the course of
my 2nd and 3rd trimester training.
By affixing my signature below, I agree to abide by all policies and procedures set forth in this
manual and I agree to the following Statement on Confidentiality:
Confidentially of the medical record is critical. All health care personnel shall uphold the client’s
right to privacy. Violation of the confidentiality of client information shall be cause for
immediate termination of access to further data and shall be considered Unprofessional Conduct,
subject to disciplinary action as set forth in this manual. Penalties for this misconduct may result
in expulsion form the National University of Health Sciences.
________________________________________________________
Signature of Intern
________________________________________________________
Date (mm/dd/yyyy)
This form must be on file with the office of the Dean of Clinics before you may see clients in the clinics. Please make a copy for yourself.
151