Clinic Handbook 2022 2023 High Res

2022-2023
GRADUATE STUDIES CLINICAL HANDBOOK
TABLE OF CONTENTS
WELCOME....................................................................................................................................................4
NON-DISCRIMINATION STATEMENT.................................................................................................5
ACCREDITATION.......................................................................................................................................5
VANDERBILT UNIVERSITY MISSION...................................................................................................5
VUMC STATEMENT OF PURPOSE.........................................................................................................5
VUMC MISSION..........................................................................................................................................6
VUMC STRATEGIC COMMITMENTS...................................................................................................6
VUMC CREDO.............................................................................................................................................6
THE VANDERBILT PATIENT & FAMILY PROMISE............................................................................7
DEPARTMENT OF HEARING AND SPEECH SCIENCES MISSION................................................7
RESPONSIBILITIES OF SUPERVISORS..................................................................................................7
RESPONSIBILITIES OF STUDENT CLINICIANS...............................................................................10
Register for Clinical Courses.................................................................................................................10
Provide Documentation of Health Screenings...................................................................................11
Complete Required Training.................................................................................................................11
CPR.......................................................................................................................................................11
Initial Compliance Training..............................................................................................................11
eStar Training (EMR).........................................................................................................................11
CALIPSO Training.............................................................................................................................11
Clinic Assignments.................................................................................................................................11
Student Expectations..........................................................................................................................12
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DEPARTMENTAL REQUIREMENTS FOR CLINICAL EDUCATION............................................12
Audiology.................................................................................................................................................13
General Information..........................................................................................................................13
4th Year Externship............................................................................................................................14
Speech-Language Pathology..................................................................................................................14
General Information..........................................................................................................................14
Externship............................................................................................................................................15
EXTERNAL CLINIC PLACEMENTS......................................................................................................16
PROFESSIONALISM..................................................................................................................................16
ETHICS.........................................................................................................................................................16
PATIENT RIGHTS......................................................................................................................................17
PATIENT PRIVACY...................................................................................................................................17
STUDENT USE OF MEDICAL RECORDS............................................................................................18
Introduction.............................................................................................................................................18
Policy........................................................................................................................................................18
Use of eStar/AudBase/TIMS..................................................................................................................19
Student Access to Electronic Medical Records-Departmental Policy.............................................19
DRESS CODE..............................................................................................................................................20
ATTENDANCE...........................................................................................................................................21
USE OF INTERPRETERS..........................................................................................................................22
TRANSPORTATION..................................................................................................................................22
SERVICES FOR STUDENTS WITH DISABILITIES............................................................................23
CENTER FOR STUDENT WELLBEING................................................................................................23
GRIEVANCE POLICY...............................................................................................................................23
SUMMARY..................................................................................................................................................24
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APPENDICES
A. VUMC Non-Discrimination and Accessibility Notice.....................................................................25
B. CALIPSO Evaluation Form - Audiology.............................................................................................26
C. CALIPSO Evaluation Form - Speech-Language Pathology..............................................................30
D. Practicum Planning Form.....................................................................................................................33
E. CALIPSO Clock Hour Form - Audiology...........................................................................................34
F. CALIPSO Clock Hour Form - Speech-Language Pathology.............................................................35
G. CALIPSO Supervisor Feedback Form.................................................................................................36
H. CALIPSO Student Evaluation of Off-Campus Placement Form.....................................................40
I. PPE Guidelines.........................................................................................................................................42
J. Eye Protection and Surgical Mask Reminders/Masking and Workplace Guidance.......................48
K. Universal Masking Guidance...............................................................................................................50
L. CALIPSO Knowledge and Skills Acquisition - Audiology................................................................53
M. CALIPSO Knowledge and Skills Acquisition - Speech-Language Pathology...............................66
N. Request for 4th-Year Externship Form...............................................................................................85
O. Request for SLP Externship Form........................................................................................................86
P. VUMC Patient Rights and Responsibilities.........................................................................................89
Q. VUMC Notice of Privacy Practices.....................................................................................................90
R. HIPAA Resource...................................................................................................................................987
S. VUMC Confidentiality Agreement....................................................................................................106
T. Health and Safety Resources................................................................................................................109
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WELCOME
The clinical education process is an exciting accompaniment to your academic program. Our
goal in the Department of Hearing and Speech Sciences (DHSS) is to provide you with the
highest quality clinical experiences. During your enrollment here, you will see individuals who
exhibit many different disorders of voice, speech, language, cognition, swallowing, or hearing.
They will be of all ages and from diverse backgrounds. You will work with skilled clinical staff
and faculty in a variety of settings. We expect you to develop clinical skills for assessment and
management of many human conditions across the lifespan. At the same time, we hope you will
begin to get an idea of how you want your professional career to evolve as you identify areas of
interest for your investigation and involvement in the future. It is our privilege to assist you in
laying the foundation for your development as a professional, and we are confident you will find
The Vanderbilt University Medical Center (VUMC) an exciting, challenging, and supportive
environment to do just that. The faculty and staff are committed to assisting you in this process,
and we are available to you, not only in the clinics and classrooms, but in our offices and
laboratories as well. We are excited to have you join us in the DHSS.
Mary Sue Fino-Szumski, Ph.D., M.B.A., CCC-A

Associate Professor and Director of Clinical Education
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NON-DISCRIMINATION STATEMENT
In compliance with federal law, including the provisions of Title VI and Title VII of the Civil Rights Act of
1964, Title IX of the Education Amendment of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973,
the Americans with Disabilities Act (ADA) of 1990,the ADA Amendments Act of 2008, Executive Order 11246,
the Vietnam Era Veterans Readjustment Assistance Act of 1974 as amended by the Jobs for Veterans Act, the
Uniformed Services Employment and Reemployment Rights Act, as amended, and the Genetic Information
Nondiscrimination Act of 2008, Vanderbilt University does not discriminate against individuals on the basis of
their race, sex, sexual orientation, gender identity, religion, color, national or ethnic origin, age, disability, military
service, covered veterans status, or genetic information in its administration of educational policies, programs,
or activities; admissions policies; scholarship and loan programs; athletic or other university-administered
programs; or employment. In addition, the university does not discriminate against individuals on the basis of
their gender expression. Requests for information, inquiries or complaints should be directed to these offices:
Equal Opportunity and Access Office, [email protected], telephone (615) 343-9336; Title IX Office, Title IX
Coordinator, [email protected], telephone (615) 343-9004, 110 21st Avenue South, Suite 975, Nashville TN
37203; Student Access Office, [email protected] telephone(615) 343-9727.
VUMC Non-Discrimination and Accessibility Notice is included in Appendix A of this handbook.
ACCREDITATION
The Master of Science (M.S.) education program in speech-language pathology (residential) and the Doctor of
Audiology (Au.D.) education program in audiology (residential) at Vanderbilt University are accredited by the
Council on Academic Accreditation in Audiology and Speech-Language Pathology of the American Speech-
Language-Hearing Association, 2200 Research Boulevard, #310, Rockville, MD 20850, 800-498-2071 or 301-296-
5700.
VANDERBILT UNIVERSITY MISSION
Vanderbilt University is, above all, a center for scholarly research, informed and creative teaching, and service to
the community and the society at large. The University avows as its essential task the unique fusing of the quest for
knowledge through scholarship with the dissemination of knowledge through teaching. Creative experimentation,
the development of high standards, and an enhanced atmosphere of intellectual freedom are both evident and
valued on this campus. In addition, the University has an inherent regional role. It recognizes that as a private
institution it is almost unique in its offerings of advanced programs in the region. Moreover, the diversity of
programs promotes an interchange manifested in a wide and rich curriculum both remarkable for its size and
complexity. Vanderbilt values an environment conducive to the cultivation of liberal learning, logical thought,
and disciplined inquiry into the education of our youth and the training of creative professionals. Vanderbilt
understands itself as self- contained and self-regulating, subject finally only to generally acknowledged standards of
excellence and a sense of responsibility to the national community. High in priority among Vanderbilt’s many goals
is to have a diversified student population.
VUMC STATEMENT OF PURPOSE
Vanderbilt University Medical Center is one of the nation’s longest serving and most prestigious academic
medical centers. Through its historic bond with Vanderbilt University, VUMC cultivates distinguished research
and educational programs to advance a clinical enterprise that provides compassionate and personalized care
and support for millions of patients and family members each year. World-leading academic departments and
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comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical
advances across the entire spectrum of health and disease. VUMC’s leadership in the delivery of academically
based health care is recognized by the nations most trusted advisory bodies and reporting organizations including
the National Academies, the Magnet Recognition Program, U.S. News & World Report, the Leapfrog Group,
Truven Health Analytics and others. Our Schools of Medicine and Nursing and residency training programs are
consistently among the most selective, and are valued for their diversity, innovation and capacity to transform the
educational experience, while the breadth of our scientific discovery is propelled by a research enterprise that is
consistently ranked among the nation’s top 10.
VUMC MISSION
Through the exceptional capabilities and caring spirit of its people, Vanderbilt will lead in improving the healthcare
of individuals and communities regionally, nationally, and internationally. We will combine our transformative
learning programs and compelling discoveries to provide distinctive personalized care.
www.vumc.org/Elevatesite/46643
VUMC STRATEGIC COMMITMENTS
• We will sustain a collaborative community fully committed to diversity and inclusion and to supporting one
another, our patients, and their families.
• We will deliver the highest quality and safest health care in a seamless manner that always places our patients
and their families first.
• We will personalize the care of every patient, fully leveraging our knowledge, values, and strength in science
and technology.
• We will invest continuously in the capabilities of our people, helping each of us realize our goals and
potential.
• We will advance the knowledge of human health through a commitment to research, a passion for learning,
and an unyielding pursuit of better ways to deliver care.
• We will improve the effectiveness and efficiency of everything we do to achieve greater value for those we
serve.
• We will provide prompt and continuous access for our patients and colleagues throughout VUMC and the
Vanderbilt Health Affiliated Network. https://www.vumc.org/strategy/vumc-strategy
VUMC CREDO
We provide excellence in healthcare, research, and education. We treat others as we wish to be treated. We
continuously evaluate and improve on performance.
• I make those I serve my highest priority.

• I respect privacy and confidentiality.
• I communicate effectively.
• I conduct myself professionally.
• I have a sense of ownership.
• I am committed to my colleagues. https://www.vumc.org/Elevatesite/53369
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THE VANDERBILT PATIENT & FAMILY PROMISE
Vanderbilt University Medical Center is committed to excellence. We will:

• include you as the most important member of your healthcare team
• respect your right to privacy
• work with you to coordinate your care
• personalize your care with a focus on your values and needs
• communicate clearly and regularly
• serve you and your family with kindness and respect
www.vumc.org/Elevatesite/53369
DEPARTMENT OF HEARING AND SPEECH SCIENCES MISSION
The DHSS is dedicated to serving persons with communicative and related disorders through treatment,
education, and research; enhancing our knowledge of communicative and related disorders; shaping the future
of communication disorders and related disciplines through national and international leadership; promoting
public awareness and prevention of communicative and related disorders; ensuring continuous improvement
of operations through personal and professional development; and generating measurable benefits for our
community, employees, students, clients and their families, and other customers.
RESPONSIBILITIES OF SUPERVISORS
Staff and faculty in clinical roles have the primary responsibility for clinical patients. While providing patient
care, clinical staff and faculty also serve as clinical supervisors for graduate students. Their top priority is always
to provide services to patients in an effective and efficient manner. A secondary responsibility of supervisors is
the clinical education of students. The interaction of the primary and secondary responsibilities presents a unique
challenge to supervisors who must address both client and student interests.
Because all clinicians who hold the Certificate of Clinical Competence (CCC) and meet ASHA requirements for
supervisors participate in clinical supervision, the department is committed to offering supervisor education on a
regular basis. Each supervisor who is new to the center or who has not supervised in the past is required to have
an individual meeting with the Director of Clinical Education, their team leader, or the coordinator of the clinic in
which they work to receive instruction in the supervisory process in general as well as in procedures specific to the
site. In addition, an annual supervisor’s workshop is conducted each year to provide supervisors with additional
knowledge and skills to support supervisory activity. All supervisors are expected to attend, and ASHA continuing
education units are awarded without cost to those who supervise students in the program, both at on-campus and
off-campus sites.
Clinical supervisors are present and/or accessible 100% of the time a student is involved in patient care. The
supervision model in all clinical placements is 1:1 (one student to one supervisor). All students are supervised
100% of the time when beginning all clinic placements. Supervisors observe and have detailed discussions with
students to determine level of support needed and level of independence for all aspects of service. When requested
by supervisors, students complete self-evaluations in CALIPSO and share them with their supervisors. Supervisors
use their observations and feedback from the student to determine level of independence and supervision.
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Supervisors are responsible for guiding students to:
• develop appropriate goals and strategies for evaluation and treatment using evidence-based practice
• develop skills in utilizing a variety of clinical techniques
• develop skills in utilizing a variety of clinical equipment/materials
• develop clinical writing skills
• develop self-evaluation skills
• develop skills in patient and family counseling
• develop skills in ethical practice
• develop professional practice competencies (accountability, integrity, effective communication skills, clinical
reasoning, evidence-based practice, concern for individuals served, cultural competency, professional duty,
collaborative practice)
To achieve the above goals, supervisors:

1. supervise students during clinical assignments (Level of supervision meets or exceeds ASHA requirements.)
2. provide written/verbal feedback about observations
3. suggest alternative procedures for implementing clinical goals
4. edit diagnostic and other reports/plans
5. demonstrate effective evaluation/treatment techniques as appropriate
6. participate in patient and family counseling sessions
7. foster independent clinical performance
8. consult with students regarding clinical procedures
During all stages of clinical practice, students benefit from feedback regarding performance. Ongoing regular
feedback is critical to the development of effective clinical skills.
Beginning Fall 2017, the DHSS began a phased implementation of CALIPSO. “CALIPSO is a web-based
application that manages key aspects of academic and clinical education designed specifically and exclusively for
speech-language pathology and audiology training programs.” (https://www.calipsoclient.com/) All new students
enrolled in the speech-language pathology and audiology educational programs beginning Fall 2017 have their
educational and academic requirements tracked in CALIPSO. For these students, mid-term evaluations and end-
of- semester evaluations are completed in CALIPSO. (Appendix B, Appendix C)
At minimum, supervisors will have the following formal interactions with student clinicians for the purpose of
evaluating student performance:
1. Goal setting for expected student performance will be completed at an initial conference using the area specific
form developed for the clinical placements site.
2. Midterm evaluations of clinical performance will be provided and discussed with the progress toward goals
highlighted.
3. Final evaluation of clinical performance will be provided and discussed with the progress toward goals
highlighted.
CALIPSO also allows students to complete self-evaluations. Supervisors are encouraged to have each student
complete self-evaluations during their clinical assignments. The following times are encouraged for self-
evaluations:
o beginning of externship
o prior to midterm
o prior to each final evaluation
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Once completed, students will share their self-evaluations with their supervisors.
The following performance rating scale is used in CALIPSO:
1 Unacceptable performance: Specific direction from supervisor does not alter unsatisfactory performance
(skill/behavior is present <25% of the time).
2 Needs Improvement in Performance/Maximum Support: The clinical skill/behavior is beginning to emerge.
Efforts to modify can result in varying degrees of success. Maximum amount of direction from supervisor
needed to perform effectively (skill/behavior is present 26- 50% of the time).
3 Moderately Acceptable Performance/Moderate Support: Inconsistently demonstrates clinical behavior/skill.
Exhibits awareness of the need to monitor, adjust, and make changes. Modifications are generally effective.
Moderate amount of direction from supervisor needed to perform effectively (skill/behavior is present 51-75%
of the time).
4 Acceptable Performance/Minimal Support: Displays minor technical problems that do not hinder the
therapeutic process. Minimum amount of direction from supervisor needed to perform effectively (skill/
behavior is present 76-90% of the time).
5 Acceptable Performance/Independent: Adequately and effectively implements the clinical skill/behavior.
Demonstrates independent and creative problem solving (skill/behavior is present >90% of the time).
Clinical supervisors are responsible for completing evaluations and rating students on evaluation items as
accurately as possible using the performance rating scale.
The final semester grade is determined by the Director of Clinical Education. In CALIPSO, evaluation scores are
weighted by the number of clock hours approved by the clinical supervisor. The Director of Clinical Education
reviews weightings and scores to assign a final semester grade. The following are possible grades:
P - Pass
F - Fail
IP - In progress (temporary grade)
VUMC supervisors are required to follow all VUMC guidance and requirements related to COVID-19 protocols
outlines on the VUMC employee website.
https://www.vumc.org/coronavirus/information-vumc-employees-and-patients
This webpage is regularly updated and supervisors should refer to them first for information about testing,
monitoring symptoms, etc.
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RESPONSIBILITIES OF STUDENT CLINICIANS
Register for Clinical Courses
All students are expected to register for the appropriate clinical course each semester. Course information for each
semester is as follows:
M.S. Speech-Language Pathology Program – 5 semesters
Year Semester Course Credits

1 Fall SLP 5583 Practicum and Clinical Case Conference 1
Spring SLP 5583 Practicum and Clinical Case Conference 1
Maymester MDE 5356 Internship/Externship (specialty track) 2
Summer SLP 5583 Practicum and Clinical Case Conference 1
Spring SLP 5355 Externship (10 weeks) 6
M.S. Speech-Language Pathology Program – 6 semesters

Maymester MDE 5356 Internship/Externship (specialty track) 2
Summer SLP 5583 Practicum and Clinical Case Conference 1
Summer SLP 5355 Externship (10 weeks) 6
Clinical Doctorate (Au.D.) in Audiology – 11 semesters

1 Fall AUD 5585-01 Practicum and Case Conference 3
Spring AUD 5585-01 Practicum and Case Conference 3
Summer AUD 5585-01 Practicum and Case Conference 3
Maymester AUD 5357 Internship/Externship Audiology (specialty track) 1
MDE 5356 Internship/Externship (specialty track) 2
Summer AUD 5585-01 Practicum and Case Conference 3
Summer AUD 5355 Externship 3
4 Fall AUD 5355 Externship 3
Spring AUD 5355 Externship 3
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Provide Documentation of Health Screenings
Students are required to submit immunization records and tuberculosis (TB) information prior to coming to
Vanderbilt University. Student who have not met immunization and health screening requirements will not be
permitted to register for classes. Detailed information on requirements and submission instructions are found
on the Student Health Center website: https://www.vumc.org/student-health/immunization-requirements-new-
students
Healthcare professional students in the School of Medicine (applies to speech-language pathology and audiology
students) are required to have an annual influenza vaccination if they are in a clinical setting between, October 1
and March 31. Consult the Student Health Center for information on the deadline and exemption request process:
https://www.vumc.org/student-health/influenza- vaccinations-students
Students are responsible for monitoring their immunization/healthscreening compliance and responding to the
need to update information/compliance in a timely manner.
Complete Required Training
CPR
Students must have on file a current CPR card. If the card expires during enrollment in the training program
at Vanderbilt, it is up to the student to obtain renewal training and provide documentation that it has been
completed. Acceptable courses are instructor-led, Basic Life Support (BLS) for Healthcare Providers CPR training
classes that cover both adults and children (Red Cross, American Heart Association, or Military Training
Network). Further information on courses and acceptable certification is found on the Vanderbilt Resuscitation
Program website: https://www.vumc.org/Resuscitation/
Initial Compliance Training

Incoming students are assigned “initial compliance” training in The VUMC Learning Exchange that consists of
training modules on HIPAA, Cyber Security, Sexual Misconduct, Code of Conduct, and Fraud, Waste, & Abuse.
In addition, students are assigned training on Bloodborne Pathogens and Infectious Diseases. This training must
be completed prior to beginning clinical practicum. This training is accessed on The Learning Exchange https://
learningexchange.vumc.org
eStar Training (EMR)

eStar is the electronic medical record used at VUMC in hospital units and outpatient clinics. Students are required
to complete eStar Live and eStar online training modules before access will be granted to the system. Online
modules are assigned, and live training is scheduled prior to the start of clinic assignments.
CALIPSO Training
CALIPSO is a web-based application that manages key aspects of academic and clinical education designed
specifically and exclusively for speech-language pathology and audiology training programs. Students receive
training during orientation which includes the following: registering in the system, accessing the system,
navigating the system, submitting clock hours, completing self-evaluations, site evaluations and supervisor
evaluations.
Clinic Assignments
Clinic assignments are made prior to the start of each semester in coordination with clinic leaders. Potential
clinical placements are based on supervisor and student availability each semester.
Entering students will be assigned to clinical experiences based on admission information and the expectations
for clinical skill development during the first semester of enrollment. MS-SLP students complete a form prior to
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starting their clinical experiences that describes their prior observation experiences and preliminary preferred
patient populations and settings. This form is shared with the Pediatric Clinical Coordinator who assigns students
to their initial placement.
Continuing students will be asked to indicate requests for assignments prior to the end of each semester. The
Director of Clinical Education sends an e-mail approximately 3 weeks prior to the end of each semester to
solicit practicum planning information from students(Appendix D). Students are instructed to answer planning
questions and return the information via e-mail to the appropriate person. These requests are considered in
relation to the students’ needs for knowledge and skill development as well as previous clinical assignments. Clinic
assignments are sent to students via email.
Student Expectations
• Students will contact the supervisor prior to the first day of clinic to set up an initial staffing/orientation at the
clinical site. Some sites will provide different instructions for orientation, and site-specific directions supersede
this guideline. Each clinical site will have its own procedures for how and where students access clinical
information and what policies and procedures are used at that site. Appropriate manuals and checklists will be
provided to assist the student in managing these responsibilities in each clinical setting.
• Students are expected to arrive prior to each clinical appointment(based on the clinic’s expectations of
appropriate arrival time) and to be prepared for the clinical assignment. Since supervisors are professional
clinicians with primary patient care obligations, students will be guided and instructed through all phases of
clinical service in an apprentice-type model.
• Students are expected to fulfill all clinical assignments.
• Students will maintain a clinical clock hour record and enter clock hours into CALIPSO on a daily basis. Clock
hours are submitted to the appropriate supervisor for approval at a frequency designated by the supervisor
(daily or weekly).(Appendix E, Appendix F)
• At the conclusion of each semester, students complete the following in CALIPSO:
o Self-evaluation – Complete a self-evaluation upon request of supervisor(s). Print out completed self-
evaluation and provide a copy to requesting supervisor.
o Supervisor Feedback Form – One form for each of the main supervisors for the semester. (Appendix G)
o Student Evaluation of Clinic Placement: One form for each of the on- and offcampus practicum sitesfor
the semester.(Appendix H)
• Students are expected to adhere to all policies and procedures, and confidentiality and privacy guidelines for
all sites where they are placed for clinical assignments.
• Students are required to abide by all PPE guidelines. (Appendix I, Appendix J, Appendix K) Students are required
to follow all Vanderbilt University guidance and requirements related to COVID- 19 protocols: https://www.
vanderbilt.edu/healthwellness/public-health/covid19/ This webpage is regularly updated and students should
refer to it first for information about testing, monitoring symptoms, etc.
DEPARTMENTAL REQUIREMENTS FOR CLINICAL EDUCATION
All students in the Master of Science program in speech-language pathology and in the Doctor of Audiology
program are required to engage in practicum as part of their enrollment. The skills and knowledge successfully
obtained from the academic and clinical curricula will qualify the student for the Certificate of Clinical
Competence from the American Speech-Language-Hearing Association (ASHA) as well as state licensure, where
applicable. Audiology graduates will also qualify for American Board of Audiology Certification.
12
A sequence of clinical education is designed for each student to provide them with a comprehensive clinical
experience and to lead to the development of the desired skills and knowledge for successful practice in each
profession.
The clinical and academic components of the training programs are designed so that all students will achieve the
skills and knowledge outcomes delineated on the Knowledge and Skills Acquisition forms (Appendix L, Appendix
M). Each student will receive updates of their progress toward achieving the required skills and knowledge
outcomes as they progress through the program. Students use CALIPSO and have access to KASA information
through that system. While students may be exposed to opportunities for learning from both professions,
regardless of major, clock hour credit and the emphasis in professional training will be given to those clinical
activities associated with the recognized Scope of Practice for the profession in which the student is majoring. The
ASHA Scopes of Practice documents for audiology and speech-language pathology are provided in the following
links:
Scope of Practice in Audiology: https://www.asha.org/policy/SP2018-00353/American Speech-Language-Hearing

Association. (2018). Scope of Practice in Audiology [Scope of Practice].
Available from www.asha.org/policy.
Scope of Practice in Speech-Language Pathology: https://www.asha.org/policy/SP2016-00343/ American Speech-

Language-Hearing Association. (2016). Scope of Practice in Speech-Language Pathology [Scope of Practice].
Available from www.asha.org/policy.
In addition to the knowledge and skills outcomes within their own scope of practice, students will meet the other
clinical and academic requirements for the Certificate of Clinical Competence awarded by ASHA.
Audiology
General Information
All Au.D. students are expected to participate and make consistent progress in developing clinical skills through
clinical practicum assignments throughout their program. Enrollment in clinical practicum is required during
each semester of the student’s enrollment. The first semester of the clinical program in audiology includes a weekly
clinical case conference survey combined with observations, guidance, and limited hands-on clinical experience.
After completion of laboratory competencies, students engage in one or two half-days per week in one of the
primary clinical sites (Odess Clinic, 9th Floor Audiology clinic, Green Hills Audiology Clinic, or Franklin ENT
Clinic) of the department during the semester.
A grade of Pass (P), Fail (F) or In Progress (IP) will be awarded for all semesters of practicum. The first-year
grading is primarily based on attendance, punctuality, professionalism, and active engagement in the learning
process. In subsequent semesters, clinical performance and learning will be the main areas of grading in addition
to areas mentioned above. The Director of Clinical Education assigns grades based on the average of all evaluation
scores completed by clinical supervisors. Clinic grades will be reduced for unexcused absences from either clinic or
clinical case conference according to prevailing departmental guidelines.
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Students should expect to have the following time commitments to clinic during enrollment in the Au.D. program.
Amounts might be adjusted in years 1-3 based on supervisor availability and class schedule:
Semester/Year Expected Clinic Time Per Week

1st Semester (Fall 1) 1-2 half-days
2nd Semester (Spring 1) 1-2 half -days
3rd Semester (Summer1 2-3 half-days
4th Semester (Fall 2) 2-3 half-days
5th Semester (Spring 2) 2-3 half-days
6th Semester (Summer 2) 3 half-days
7th Semester (Fall 3) 4 half-days
8th Semester (Spring 3) 4 half-days
9th Semester (Summer 3) Full-time (4-5 days)
10th Semester (Fall 4) Full-time (4-5 days)
11th Semester (Spring 4) Full-time (4-5 days)
4th-Year Externship
During the summer of the second year, Au.D. students begin the application process for 4th-year clinical
externship placements. Students are guided through the externship application process by the Director of Clinical
Education and faculty and staff in the audiology program. The Director of Clinical Education meets with all rising
3rd-year students prior to the summer of their second year and provides detailed information regarding 4th-year
externships and the assistance provided by the department.
Following this meeting, students complete a Request for 4th-Year Externship Form (Appendix N) where they
generally describe the type of placement they are seeking (VUMC vs. external, city, state, employer, pediatrics/
adults, private practice, schools, VA, outpatient, etc.) and list up to 6 sites in order of preference. Students may
not contact sites directly at this point in the process. The Director of Clinical Education meets with each student
individually to review their preferences and list of sites. The Director of Clinical Education then contacts sites
to obtain detailed information regarding availability of externships and the application process. The Director of
Clinical Education completes this process and meets with students individually, again, to discuss the information
and sites they wish to submit applications. It is recommended that students apply to at least 5 sites. Students are
responsible for completing the applications and gathering all documentation needed for the applications. All
placements are contingent upon a fully executed affiliation agreement.
Externships begin on or about July 1 (during the summer of the third year) and continue for a minimum of ten
months (e.g. through Fall and Spring of the 4th year). Typical end dates for externships are around April 30 of the
fourth year. Students may receive financial support from the externship facility during the fourth-year externship.
Financial support provided by externship sites varies greatly, and this support is solely the responsibility of the
externship site. Students are responsible for all expenses related to externship (travel, housing, transportation,
background checks, etc.).
Speech-Language Pathology
General Information
All M.S. SLP students are expected to participate and make consistent progress in developing clinical skills through
clinical practicum throughout their program. Enrollment in clinical practicum is required during each semester of
the student’s enrollment.
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Entering speech-language pathology students are enrolled in SLP 5883, a weekly case conference survey, and SLP
5305, a clinical practice course, to develop a foundation of skills and knowledge to permit clinical participation.
Additionally, a typical weekly clinical assignment for the first-semester student is 2 -3 half-days (9 to 12 clock
hours) of clinical practicum under the 100% direction of a certified supervisor. While the course content in SLP
5883 is expected to be sufficient to allow a student to have some information on which to base clinical activities,
all clinics assess students’ preparation for their clinical assignments and provide one-on-one instruction, readings,
demonstration, and modeling as appropriate until the student can demonstrate skills for limited engagement in
hands- on therapy. This procedure is used for subsequent semesters if classes have not been completed that would
underpin the clinical experience. After the first semester, speech-language pathology students engage in 4-5 half-
days (14-20 hours) per week of clinical assignments. The 5th semester (or 6th semester, depending on admission
qualifications) includes a 10-week full-time externship.
Students complete 25 clock hours of guided clinical observation supervised by a licensed clinician who holds the
Certificate of Clinical Competence (CCC) in Speech-Language Pathology from the American Speech-Language-
Hearing Association during clinical assignments and meets the requirements for supervisors established in
the 2020 Standards for the Certificate of Clinical Competence in Speech-Language Pathology(www.asha.org/
certification/2020-slp-certification- standards). Guided observation is integrated into each clinical placement prior
to the student engaging in direct patient care.
A grade of Pass (P), Fail (F) or In Progress (IP) will be awarded for all semesters of practicum. The first- semester
grading is primarily based on attendance, punctuality, professionalism, and active engagement in the learning
process. In subsequent semesters, clinical performance and learning will be the main areas of grading in addition
to areas mentioned above. The Director of Clinical Education assigns grades based on the average of all evaluation
scores completed by clinical supervisors.
Externship
During the final semester of enrollment students will complete a 10-week, full-time externship experience in a
facility to be determined based on the student’s interest and on facility availability. Students do not receive payment
or salary during the externship period, but financial support (remitted tuition) in place for the regular academic
semester will continue during the externship. Students are responsible for all expenses related to externship (travel,
housing, transportation, background checks, etc.). Students are expected to have completed approximately 300
clinical clock hours (including guided observation hours) prior to initiation of the externship.
Externship planning begins in the spring of the first year of the program. The Director of Clinical Education and
Director of Student Community Engagement meet with all 1st-year M.S. speech-language pathology students in
February or March and provide detailed information regarding externships and the assistance provided by the
department. Following the meeting, students complete a Request for SLP Externship Form (Appendix O) where
they generally describe the type of placement they are seeking (VUMC vs. external, state, city, employer, pediatrics/
adults, private practice, schools, VA, outpatient, etc.) and list at least three sites in order of preferences. Students
may not contact sites directly at this point in the process. The Director of Student Community Engagement meets
with the students individually to discuss their completed form and the specific sites where they wish to pursue a
placement. The Director of Student Community Engagement then contacts sites to obtain detailed information
regarding availability of externships, the specific patient populations and clinical specialties, and the application
process (if any). Students may only consider sites that will provide an experience that will lead to ASHA
certification. Students are responsible for completing applications (if applicable) and gathering all documentation
requested by the externshipsite for consideration for placement. They update the Director of Student Community
Engagement on the status of their applications and offers. If there is not a formal application and the Director
of Student Community Engagement is notified that a site would like to host a student, the Director of Student
Community Engagement notifies the student of confirmation of placement. All placements are contingent upon a
fully executed affiliation agreement between Vanderbilt University and the clinical externship site.
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EXTERNAL CLINIC PLACEMENTS
All students are placed in VUMC clinics for their first semester. Students must have demonstrated expected
performance for their level of study in the program to be placed at an external site (outside of VUMC). Students
are placed at external sites when the clinical experience is sequenced with coursework and they have had
experience in a VUMC clinic.
The Director of Clinical Education and the Director of Student Community Engagement contact potential external
sites to investigate willingness to host students for clinical experiences. When possible, the Director of Clinical
Education and/or the Director of Student Community Engagement tour sites to meet with clinic leadership and/or
staff and discuss the patient population seen at the site, patient volume, equipment used, and procedures that are
performed at the site. The website for the facility is reviewed and credentials of staff who would potentially work
with students are verified. If it is not possible to visit a site, a phone conversation with clinic leadership and/or staff
is conducted to obtain similar information that would be gathered at an onsite visit.
External placements begin only after information is obtained to determine the educational needs of a student will
be met and an affiliation agreement has been executed between Vanderbilt University and the facility. Students
must be in compliance with all health screening, training, background and/or drug screening requirements and
provide any documentation necessary to be onboarded by an external site prior to beginning their assignment.
Student progress is monitored by the Director of Clinical Education via e-mail and phone communication while
completing clinic assignments at external sites. External supervisors are granted access to CALIPSO and receive
training material and support from the Director of Clinical Education on the application. The information
described in “Responsibility of Supervisors” above applies to internal and external supervisors.
Feedback regarding supervisors and external sites is provided by students in CALIPSO using the Supervisor
Feedback Form (Appendix G) and Student Evaluation of Off-Campus Placement Form (Appendix H).
PROFESSIONALISM
Professionalism is difficult to define precisely, although almost everyone can recognize it when they see it— and,
perhaps more importantly, perceive its absence. The characteristics of professionalism which are more readily
discussed include such aspects as clinical dress, promptness, preparedness, and responsibility for tangible items
like materials and equipment. However, those characteristics that set a professional apart from a technician are the
more intangible aspects of professionalism. The application of accepted theoretical and ethical principles, the use of
evidence-based practice, a commitment to the welfare of the patient, cooperation with other professionals, respect
for patients and family members and their privacy, and a willingness to accept direction from those who are more
experienced are integral aspects of professionalism. During the clinical practicum experience, students will have
the opportunity to observe clinicians, faculty, and other students providing examples of professional behavior. It is
expected that students will emulate those who provide the best examples.
The CALIPSO Evaluation Form guides supervisors in evaluating the professional behaviors of students (Appendix
B, Appendix C). However, students are also expected to demonstrate the less measurable aspects of professionalism
which are not listed on the form but which nonetheless will be evaluated.
ETHICS
Professional ethics and ethical conduct have moved to the forefront of the thinking of patients and service
providers in recent years. This may be a reaction to a period when it appeared that professionals were only
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giving lip-service to their ethical responsibilities. For whatever reason, the increasing emphasis on ethics and
the relationship of ethical conduct to evidence-based practice is extremely positive. All individuals who teach or
provide services in the Department of Hearing and Speech Science are expected to abide by a Code of Ethics. The
Code of Ethics of the American Speech- Language-Hearing Association (ASHA) is provided in the following link:
ASHA Code of Ethics https://www.asha.org/Code-of-Ethics/

American Speech-Language-Hearing Association. (2016). Code of Ethics [Ethics]. Available from www.asha.org/
policy
AAA Code of Ethics https://www.audiology.org/sites/default/files/publications/resources/201910-
CodeOfEthicsOf-AAA.pdf
In its preamble, the code is described as both inspirational and aspirational. While we aspire to abide by the Code’s
tenets, it should also inspire us to better practice than even that which is described in its principles and rules. The
ASHA Code of Ethics delineates our responsibility to the welfare of our patients, our responsibility to behave as
a professional, as well as our responsibilities to other professionals and to the public. While this code describes
principles and rules for the professions of audiology and speech-language pathology, it is clearly based on the
ethical values of autonomy, beneficence, confidentiality, harm avoidance, justice, professional responsibility, and
truth.
All students, as well as faculty members and clinicians, are expected to abide by the Code of Ethics of the
American Speech-Language-Hearing Association in their conduct of clinical and academic responsibilities in the
department. It is assumed that those values which are practiced here will continue to guide the student as they
enter the profession upon graduation.
PATIENT RIGHTS
Vanderbilt University Medical Center and its departments and clinics have a strong commitment to patient rights.
Our Center provides treatment without regard to race, nationality, religion, beliefs, age, disability, sex, sexual
orientation, gender identity or expression, or source of payment. Our patients are entitled to safe, considerate,
respectful, and dignified care at all times. Patients are encouraged to ask questions about their rights if they do not
understand. If patients have concerns about the quality of care received, they are encouraged to contact the Office
of Patient Relations: 615-322-6154.
At intake each patient is given the Vanderbilt publication “Patient Rights and Responsibilities,” which provides
details about patients’ rights. This publication is available in Spanish upon request. Students should be familiar
with this document and be prepared to explain it to patients who have questions (Appendix P).
PATIENT PRIVACY
Vanderbilt University Medical Center is committed to patient privacy. Information about patients and their health
is personal and private. The Vanderbilt Bill Wilkerson Center is also committed to protecting the documents and
records of the care and services we provide. While documentation is an extremely important part of quality care,
the Center and its representatives must comply with requirements regarding the ways in which clinical information
can be used and shared. Patients will receive information in the form of a Notice of Privacy Practices (Appendix
Q), which further describes their legal rights to confidentiality. This notice is available from all clinical sites.
Students should read and be aware of the contents of this document and be prepared to answer patient questions
about it. Additionally, an internal VUMC document on HIPAA (Appendix R) is available to all clinicians and
students to further amplify the effect of HIPAA on clinical activities within the center.
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All students must engage in the medical center’s HIPAA training program upon enrollment in the department.
This training is conducted as part of pre-orientation, on-line activities. Additionally, students must read and sign
the Vanderbilt Confidentiality Agreement (Appendix S).
STUDENT USE OF MEDICAL RECORDS
Introduction
Documentation of a patient encounter is as important when a graduate student assists a qualified provider
(supervisor) in providing the care as when care is rendered by the qualified provider only. Requirements for
accurate and comprehensive documentation are essential when student learning is involved. Documentation
justifies why a patient was seen, the assessment or treatment procedures used, the results of assessment and
treatment, and the recommendations for follow-up. To become a competent professional, students-in-training
must learn how to complete assessments and treatments and also, how to record clinical activities for the benefit of
the patient, for continuity of care, and to obtaining reimbursement for the services rendered.
Medicare allows limited billable interactions between students and beneficiaries. Guidelines for line-of- sight
supervision and responsibility for clinical decision making by the qualified professional maybe accessed and
are applicable to Medicare Part A (hospital and skilled nursing facility patients), Medicare Part B, and Medicaid
patients. While all services to patients governed by CMS guidelines must adhere to those rules, the purpose of
this document is to address only issues associated with documentation in the electronic medical record regarding
student-authored reporting.
Policy
It is accepted policy in the Department of Hearing and Speech Sciences (DHSS) that graduate students in speech-
language pathology and audiology may participate in the submission of documentation to the electronic medical
record. The supervisor and primary provider of the service should determine the student’s role in documentation
based on knowledge of the student’s level of clinical competency and familiarity with the electronic record system.
The supervisor must sign all documentation. The student can author the documentation and, optionally, can sign
in addition to the supervisor. The supervisor’s signature is necessary for billing/reimbursement and to verify the
accuracy of the information that has been documented (Pub 100-02 Medicare Benefit Policy Manual, Chapter15
[Covered Medical and Other Health Services], sections 200 and 230). The qualified professional is responsible for
the services and, as such, signs all documentation.
The supervisor’s signature, when the student has contributed to the report, indicates that the supervisor has
reviewed, edited, and approved all entries into the medical record and that the record accurately reflects the care
and recommendations for the patient on the date of service. To alleviate concerns about plagiarism of student-
authored notes, one of the following descriptors may be used to clarify authorship in the medical record:
1. Treatment was conducted with one-on-one supervision of co-signing therapist
2. Co-signing therapist provided onsite supervision during the course of today’s care. Treatments rendered were
determined to be appropriate for patient’s current status.
3. Co-signing therapist provided onsite supervision during the course of today’s care (with added comments).
(Message from C. Lackey, Informatics Center, to M. Fino-Szumski, 9/14/2010, re: Co-sign notations) In most
instances it appears that Option #3 above would best reflect the typical scenario when a student assists in the
evaluation/treatment session, prepares some or all of the report of the session which is edited by the supervisor,
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and receives final approval from the supervisor for the report to be submitted. In all instances, all guidelines or use
of the electronic medical records system must be observed, notably that a student or a supervisor must be signed in
under their own name and password to enter information into the record.
Departmental policies which comply with Medical Center policies for student access to the electronic medical
record system are given below.
Use of eStar/Audbase/TIMS
eStar, Audbase, and TIMS are the electronic record keeping programs used within the Department of Hearing
and Speech Sciences. All patients will have information regarding intake and treatment in the medical record
system. Only qualified providers (certified clinicians) are able to enter information independently into any of the
healthcare documentation systems. However, learning an electronic charting system is considered to be a desirable
component of student clinical education. As such, guidelines have been developed for student/supervisor use of
the systems. Additionally, all students must engage in the appropriate eStar, Audbase, and/or TIMS training as
part of their orientation program in order to understand the regulations for accessing and sharing information
within the system. The use of electronic patient care information is also governed by patient privacy guidelines and
HIPAA requirements.
Student Access to Electronic Medical Records – Departmental Policy
1. Security clearances: All MS-SLP and AuD graduate students will be expected to have completed basic training
for eStar and to have signed an annual confidentiality agreement and received security clearance prior to
having received their personal eStar access.
2. Competencies: Beyond basic eStar training, unit-specific training for students may be provided as needed.
Audiology students will receive training and access to Audbase and TIMS where required and appropriate.
Competencies maybe evaluated according to the guidelines in each division/program.
3. Passwords: At no time is any supervising clinician to allow a student to access the electronic medical record via
his/her password. Sharing the password with another person is considered to be a HIPAA violation, requiring
suspension.
4. Access to the records: Students will be allowed to access, via their own passwords, any record that directly
relates to a case within their current clinical assignments. They may review and access information in the
records only when they have a legitimate “need to know” that information. Access is monitored and must be
directly related to patient care.
5. Inputting documentation: Students are not to document any information within the medical record without
direct instructions from a supervisor and only in the following conditions:
a. Treatment was conducted with one-on-one supervision of co-signing therapist
b. Co-signing therapist provided onsite supervision during the course of today’s care. Treatments rendered
were determined to be appropriate for patient’s current status.
c. Co-signing therapist provided onsite supervision during the course of today’s care (with added comments).
6. Protection of Health Information: At no time is a medical record to be printed by students for review. At no
time is the medical record to be accessed from home (requires a security clearance), and at no time are any
paper clinical records of any kind to be duplicated, Xeroxed, and/or removed from the facility.
7. Limitation to the medical record system: Protected health information may not be developed in Word
Documents or e-mailed, faxed, or transmitted in hard copy outside of the electronic medical record.
8. Use of medical records for Clinical Case Conference/Class Case Presentations: Students may access the entire
electronic record for a patient to whom they have been assigned for purposes of a clinical case conference or
class case presentation. However, all patient identity that is part of the protected health information must be
19
removed prior to the presentation. Photographs, videos, and recordings of patients may only be used in case
conference after completion of a release form by the patient or designated representative.
9. Research: Medical records cannot be accessed for research purposes unless the protocol for the study and
medical record access has been approved by the Institutional Review Board (IRB).
DRESS CODE
The Vanderbilt University Medical Center Dress Code applies to all personnel at the Medical Center and affiliated
off-campus sites. The dress code specifically addresses patient care areas. The clinic directors in the Department
of Hearing and Speech Sciences (DHSS) at the Vanderbilt Bill Wilkerson Center have decided that it is important
that students adhere to the same dress code as staff members when they are in patient-care areas. Please
understand that the dress code is for the purpose of demonstrating respect to our patients, their families, and other
professionals. Practicum assignments in hospital areas will require the use of a lab coat, and all students should
purchase a blazer-style lab coat for this purpose.
Dress Code guidelines are as follows:
ID badges/nametags must be worn in clear sight above the waist with name, title, and picture clearly visible.
• Apparel must be clean, neat, and in good condition.
• Dresses and skirts should be no shorter than 2 inches above the very top of the knee.
• Hair should be clean, neatly trimmed, and contained in such a manner that it does not come in contact with
the patient or visitors.
• As specified by OSHA standard, personnel providing direct patient care wear socks or stockings and shoes
with impermeable enclosed toes. Shoes are constructed of an impervious, non-absorbent material, clean, and
in good repair.
• Fingernails should be clean and well cared for and no longer than ¼ inch from the fingertip in length. Artificial
and long natural fingernails are not permitted for those providing direct patient care. The definition of artificial
fingernails includes, but is not limited to, acrylic nails, all overlays, tips, bondings, extensions, tapes, inlays,
and wraps. Nail jewelry is not permitted. Nail polish, if worn, is well maintained. Chipped nail polish is not
allowed.
• Lab coats or uniforms may be worn by graduate students.
The following are not allowed:

• faded, torn, ripped, or frayed clothing;
• midriff or off-the-shoulder blouses, sweaters, or dresses;
• tight, sheer, or revealing clothing;
• clothing with advertisements, sayings, or logos, with the exception of unit-approved VUMC apparel when
worn as part of the uniform;
• spaghetti strap or strapless shirts or dresses;
• scrubs except for when providers are scheduled to be in the operating room or are part of the job uniform.
(This applies to VUMC scrubs. Note: During COVID-19, wearing personal scrubs is acceptable, if permitted
by the clinic.)
• denim material and colored denim of any kind(jeans, jackets, skirts, shirts or vests).
• visible tattoos greater than 1 inch or gross tattooing (graphic/disturbing, e.g. displaying violence, gangs, drugs,
sex, alcohol, or tobacco products) on face, neck, arms, legs, or hands should be covered.
20
• visible body piercing/jewelry except for ears and small nose studs. (earrings and nose studs should not distract
from patient care)
• gauged ears: flesh colored plugs must be worn at work
• shorts or sports attire, unless part of the unit-approved VUMC uniform; with exception to: knee-length dress
shorts with jacket or vest for women (no denim material)
• sports attire including jogging suits, sweatpants, or lycra leggings unless required for a specific position
• hats, caps, bandanas, plastic hairbags/shower caps worn in the building, excluding surgical/medical coverings
(head covering for safety purposes or established religious customs are excluded from this policy)
• flip-flops or sports sandals, excluding clogs and sling backs
• noticeable cologne, after shave, scented lotion, or perfume worn in patient care areas
In selecting clothing that adheres to these standards, students should also be governed by the concept of
professionalism. Patients should recognize student clinicians as knowledgeable service providers. As such, the
image a student presents is extremely important. Clothing that is too casual may appear disrespectful to older
patients. Clothing that is too revealing or tight may also project an incorrect image. Students should always be
aware that patients’ families or other professionals might be observing their work in our clinic areas. When viewed
from the observation room, the student’s clothing is visible from front and back, and attention should be given
to the image portrayed from all sides. Supervisors will assist students in determining if visible tattoos should
be covered during clinical activities; however, tattoos on the lower back and in the waist, area should never be
exposed since the midriff and surrounding areas must be covered at all times. Tattoos greater than 1 inch in size,
anywhere on the body, must be covered. In most instances professional dress differs significantly from clothing that
is acceptable for lounging and sports activities, attendance at religious services, and participation in social outings.
Supervisors are expected to give students feedback regarding clinical attire. If students feel that a supervisor is not
modeling appropriate clinical dress, then the student should discuss concerns with the supervisor first. If a pattern
of inappropriate clinical attire continues, the student may bring his or her concerns to the Director of Clinical
Education and should not assume that they may emulate the style of dress of the supervisor.
In some clinics, dress codes may vary. Some clinics will require the use of laboratory coats while others will allow
scrubs to be worn due to the nature of the clinical activity. Clinics in which young children are treated may allow
students to wear clothing which will be comfortable when sitting on the floor and that will resist stains. In all
instances, it is appropriate for the student to seek guidance from the supervisor.
The image that students present in our clinics becomes a part of the patient’s overall impression of the DHSS,
Vanderbilt Bill Wilkerson Center, and the Vanderbilt University Medical Center. It is expected that the image will
enhance patients’ positive perceptions of these centers. (Rev. 08/25/17)
Reasonable accommodations are made for dress or grooming directly related to an employee’s religion, ethnicity,
or disability unless such accommodations pose a risk to the safety or health of the individual or others.
ATTENDANCE
Student attendance is required at every clinical session throughout the duration of each practicum assignment
unless otherwise scheduled by the supervisor. Only those absences due to illness or similar unanticipated
emergencies may be excused; these should be reported immediately and directly to the supervisor. In rare
instances, a student may be excused from attendance at a clinical appointment for a compelling reason. When this
occurs, the student must work with the supervisor to makeup the session. Patient appointments should never be
cancelled without consultation with the supervisor. If the supervisor cannot be reached directly, then a voice mail
message should be left or using any other preferred communication method specified by the supervisor. Clinical
21
attendance may be rescheduled for limited reasons (ex: special presentation by guest speaker, conference, etc.) at
the direction of the Director of Clinic Education. These cases will be communicated to students and supervisors
in advance of the event. Clinical practicum and class instruction are viewed as equally important components of
graduate education.
Student clinician absences do impact clinical/supervisory operations in several ways. If absences are repeated,
they may leave supervisors, clients, and/or parents with the impression that clinical work is less important to the
student than are classes or other activities. If clients need to be cancelled, clinic revenue is lost. If a supervisor
needs to rearrange the day’s schedule, cancel another commitment, find someone else to assist, or conduct a
substitute treatment session with a lesson plan, valuable time is lost to the patient involved and the continuity of
service maybe disrupted. Finally, if projected skills and knowledge outcomes are not achieved by the end of an
assignment, a student’s future clinical placement options may be limited, and they may not make expected progress
in skills acquisition.
The role of a student clinician, whether at the beginning or advanced levels, should be undertaken as responsibly
and seriously as that expected of a certified clinician in any work setting. The purpose of supervised practicum is
not only to develop clinical skill but also to instill professional responsibility.
USE OF INTERPRETERS
It is the policy of the Medical Center to provide qualified interpreter services (either in-person or by telephone) for
patients whose primary language is other than English. If you are scheduled for a patient who requires interpreter
services, consult with your supervisor on the interpreter services that have been arranged for the patient visit.
Bilingual Workforce Members must take a language fluency and healthcare terminology assessment in both
English and the target language in order to communicate (within the key functions of his/her role), directly with
patients in the target language. For nonmedical communication, Workforce Members are given an appropriate
assessment coordinated by Vanderbilt Interpreter Services. None of these assessments result in permission
for bilingual Workforce Members to interpret for other people, family members, colleagues, or patients. Once
language fluency skills are assessed, if a passing score is received, the Workforce Member will be credentialed as
a “Qualified Bilingual” (with language noted) and can then communicate directly with their own patients in the
target language when facilitating care. This is not considered interpreting and does not enable that Workforce
Member to interpret for his/her own patients or the patients of other Workforce Members.
Students should familiarize themselves with the guidelines for the use of interpreters in clinical settings by
accessing this information on the ASHA website, as well as in print and other materials in the clinical areas.
Supervisors can also provide valuable guidance in these instances.
Vanderbilt University Medical Center Interpreter Services:

https://www.vanderbilthealth.com/information/interpreter-services ASHA Resources:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935334&section=Overview
TRANSPORTATION
Students may be placed for educational experiences in clinical sites located away from the Vanderbilt University
campus and may be locations in counties surrounding Davidson County (Nashville). Generally speaking, students
should be prepared to drive up to 60 miles (one way) from the Vanderbilt University campus to reach off-site
placements. External placements maybe up to three days per week for an entire semester. Students are responsible
for their own transportation to and from all clinical sites for educational experiences, including all costs associated
with that travel.
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SERVICES FOR STUDENTS WITH DISABILITIES
Students seeking accommodations for any type of disability are encouraged to contact Student Access Services.
Accommodations are tailored to meet the needs of each student with a documented disability. Specific concerns
pertaining to services for people with disabilities or any disability issue should be directed to the Disability
Program Director, Student Access Services. Mailing address: PMB 407726, 2301 Vanderbilt Place, Nashville,
Tennessee 37240-7726. Walk-in address: 108 Baker Building. Phone(615) 343-9727; fax (615) 343-0671; https://
www.vanderbilt.edu/student-access/. Step-by-step instructions for applying for accommodations through the
Commodore Access Portal’s student application page can be found here: https://www.vanderbilt.edu/student-
access/how_to/get_accommodations/index.php.
Equal Opportunity and Access (EOA) and handles all discrimination issues for faculty, staff and students. EOA
also processes disability accommodation for faculty and staff, as well as religious accommodation requestsfor all.
Its website is: https://www.vanderbilt.edu/eoa/
The Title IX and Student Discrimination office has changed its name to Title IX and handles sexual harassment
issues. Its website is: https://www.vanderbilt.edu/title-ix/
Student Access Services remains responsible for student accommodation, excluding religious accommodation.
https://www.vanderbilt.edu/student-access/
CENTER FOR STUDENT WELLBEING
The Center for Student Wellbeing seeks to create a campus culture that supports students in cultivating lifelong
wellbeing practices. The center also works closely with campus partners, including the University Counseling
Center (https://www.vanderbilt.edu/ucc/), the Student Health Center, the Office of Housing and Residential
Education, and the academic deans to provide resources and support for students who may be facing personal or
academic challenges. The Center for Student Wellbeing is centrally located on campus at 1211 Stevenson Center
Lane, across from the Student Health Center, and is open Monday through Friday, 8:00 a.m. to 5:00 p.m. For more
information, please call (615) 322-0480 or visit https://www.vanderbilt.edu/healthydores/.
Additional resources are found in Appendix T.
GRIEVANCE POLICY
Students who have a grievance regarding performance evaluations or other matters that they have been unable
to resolve with a supervisor or professor, should take their concerns to a third party. If the complaint is with a
supervisor, then the student should confer with the Director of Clinical Education. If the complaint is regarding
an academic grade, then the student should meet with the academic advisor (unless the advisor is the person
involved in the complaint; then the student should meet with the Vice Chair for Graduate Studies). If the advisor
is unable to help the student resolve the grievance, then the student should meet with the Vice Chair for Graduate
Studies. In instances in which there are both academic and clinical concerns, the student may ask to meet with
both the Vice Chair of Graduate Studies and the Director of Clinical Education. If resolution still is not achieved,
the student may go to the Chairman of the Department. Students may then follow university procedures for
complaining to the Medical School as appropriate. The student may seek guidance or communicate directly with
the Council on Academic Accreditation (CAA) if they choose.
Vanderbilt University Complaint and Grievance Procedure:

https://www.vanderbilt.edu/student_handbook/university-policies-and-regulations/#complaint-and- grievance-
procedures
23
If students have concerns regarding sexual harassment, discrimination, or intimidation, they are referred to the
Vanderbilt University website for Title IX and Student Access. These sites provide procedures for filing a complaint
or formal grievance.
https://www.vanderbilt.edu/student-access/grievances.php https://www.vanderbilt.edu/title-ix/
SUMMARY
This manual is a tool to help students to navigate their clinical responsibilities. Students should become familiar
with its content as well as the appended documents and listed resources. This manual is a useful reference tool
through the graduate program. If there are questions regarding the content of this manual, the student is urged to
ask the Director of Clinical Education for clarification.
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Appendix A
VUMC Non-discrimination and Accessibility Notice
Vanderbilt University Medical Center complies with applicable federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability or sex. VUMC does not exclude people or treat them
differently because of race, color, national origin, age, disability, or sex.
The Medical Center:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- qualified sign language interpreters
- written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
- qualified interpreters
- information written in other languages
If you need these services, contact Employee and Labor Relations.
If you believe that VUMC has failed to provide these services or discriminated in another way on the basis of race,
color, national origin, age, disability, or sex, you may file a grievance in person, by mail, fax, or email. If you need
help filing a grievance, Rochelle Johnson, Director, Employee and Labor Relations, is available to help you. File
your grievance with:
Rochelle Johnson, Director, Employee and Labor Relations 2525 West End Avenue, Suite 500
Nashville, TN 37203
615.343.4759 (phone)
615.343.2176 (fax)
Email: [email protected]
You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil
Rights, electronically through the Office for Civil Rights Complaint Portal, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Ave., SW

Room 509F, HHH Building Washington, D.C. 20201
1-800-368-1019, or 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
25
Appendix B
Appendix B
26
CALIPSO
Cumulative Evaluation
Doe, Jane
Young Child (0-5)
Child (6-17)
Adult (18-64)
Older adult (65+)
Performance Rating Scale
1 - Unacceptable performance 4 - Acceptable Performance/ Minimal Support
2 - Needs Improvement in Performance/ Maximum Support 5 - Acceptable Performance/ Independent
3 - Moderately Acceptable Performance/ Moderate Support
Severity of Disorders (check Interprofessional (or collaborative) practice (IPP) Client(s)/Patient(s) Multicultural Aspects Client(s)/Patient(s) Linguistic Diversity
Within Normal Limits Dentist Ethnicity English
Mild Dietitian Race English Language Learner
Moderate Family Member Culture Primary English dialect
Severe Nurse National origin Secondary English dialect
Occupational Therapist Socioeconomic status Bilingual
Pharmacist Gender identity Polyglot
Physical Therapist Sexual orientation Gender identity
Physician Religion Sign Language (ASL or SEE)
Physician Assistant Exceptionality Cognitive / Physical Ability
Psychologist/School Psychologist Other Other
Recreational Therapist
Social Worker
Special Educator
Speech-Language Pathologist
Teacher (classroom, ESL, resource, Teacher of Deaf and
Vocational Rehabilitation Counselor
Other
Prevention, Screening and Identification Score
1. Educates the public/those at risk and promotes hearing wellness across the life span (std II-B1, II-B2)
2. Participates in prevention/conservation programs (std II-B3, II-B4, II-B-7; std 3.1.3A-1, 3.1.3A-2, 3.1.3A-6, 3.1.3 A-9)
3. Performs hearing screeenings that are developmentally, culturally, linguistically and clinically appropriate across the life span (std II-B5, II-B6, II-B8, II-B9, II-B14; std 3.1.3A-3, 3.1.3A-5, 3.1.3A-7)
4. Performs speech/language screenings and identifies individuals at risk, using clinically appropriate and culturally sensitive screening measures (std II-B10, II-B11, II-B12, II-B13, II-B14; std 3.1.3A-4,
3.1.3A-5, 3.1.3A-7)
Number of items scored: 0 Number of items remaining: 4 Section Average: 0.00
Page 1/4 * September 11 2020 * Cumulative Evaluation

Assessment Score
1. Gathers/reviews/evaluates information from referral sources and obtains a case history and client/patient narrative to facilitate assessment, planning and identification of potential etiologic factors (std II-C1,
II-C2, II-C3; std 3.1.4A-1, 3.1.4A-2)
2. Performs an otoscopic examination (std 3.1.4A-3)
3. Removes cerumen, when appropriate (std 3.1.4A-4)
4. Selects, performs and interprets a complete immittance test battery based on patient need and other findings (std II-C7)
5. Selects, performs, and interprets developmentally appropriate behavioral pure-tone air and bone tests, including extended frequency range when indicated (std II-C8)
6. Selects, performs, and interprets developmentally appropriate behavioral speech audiometry procedures to determine speech awareness threshold (SAT), speech recognition threshold (SRT), and word
recognition scores (WRSs); obtaining a performance intensity function with standardized speech materials, when indicated (std II-C9)
7. Evaluates basic audiologic findings and client/patient needs to determine differential diagnosis and additional procedures to be performed (std II-C10)
8. Selects, performs, and interprets tests for nonorganic hearing loss (std II-C13)
9. Assesses tinnitus (std II-C5; std 3.1.4A-9, 3.1.6A-2, 3.1.6A-8)
10. Provides assessment of sound tolerance problems to determine the presence of hyperacusis (std II-C6)
11. Selects, performs, and interprets otoacoustic emissions testing (std II-C12)
12. Selects, performs, and interprets physiologic and electrophysiologic test procedures, including electrocochleography, auditory brainstem response with frequency-specific air and bone conduction threshold
testing and click stimuli for neural diagnostic purposes (std II-C11)
13. Selects, performs, and interprets vestibular testing, including for rehabilitation (std II-C14; std 3.1.4A-10, 3.1.6A-3)
14. Selects, performs, and interprets tests to evaluate central auditory processing disorder (std II-C15)
15. Identifies, describes, and differentiates among disorders of the peripheral and central auditory systems and the vestibular system (std II-C4)
16. Performs assessment for aural (re)habilitation, which may include hearing aid, assistive listening device, and sensory aid assessment (std 3.1.6A-1, 3.1.6A-7)
17. Selects and uses outcomes measures that are valid and reliable indicators of success in 1) assessment protocols that are used, and 2) determining the impact of changes in structure and function of the
auditory and vestibular systems (std 3.1.4A-20, 3.1.5A-5)
18. Performs audiologic assessment using behavioral, physiological (e.g. immittance, wideband reflectance, evoked potentials), psychophysical, and self-assessment tools (std 3.1.4A-6)
19. Administers clinically appropriate and culturally sensitive functional assessment tools across the lifespan and the continuum of care (std 3.1.5A-1, 3.1.5A-3, 3.1.5A-4)
20. Administers clinically appropriate and culturally sensitive assessment measures (std 3.1.4A-5)
21. Uses techniques that are representative of the challenges listeners may face in everyday communication situations (std 3.1.4A-7)
22. Performs assessment to plan for rehabilitation (std 3.1.4A-8)
23. Interprets results of the evaluation to establish type and severity of disorder (std 3.1.4A-12)
24. Generates recommendations and referrals resulting from the evaluation process (std 3.1.4A-13)
25. Assigns the correct Common Procedural Terminology (CPT) code(s) and the correct International Classification of Diseases (ICD) code(s) after assessment (std 3.1.4A-18)
Audiologic (Re)habilitation Score
1. Engages clients/patients, family members and other professionals in identification, assessment and treatment (std II-E1, II-E2, II-E3, II-E-4, II-E5; std 3.1.6A-11)
2. Develops and implements individualized intervention/treatment plans based on client/patient preferences, abilities, communication needs and problems, and related adjustment difficulties (std II-E6, II-E7;
std 3.1.6A-4)
3. Assesses efficacy of interventions for auditory and balance disorders (std II-E28; std 3.1.6A-14)
4. Recommends, dispenses, and services prosthetic and assistive devices (std 3.1.6A-9)
5. Provides hearing aid, assistive listening device and sensory aid orientation (std 3.1.6A-10)
6. Selects, fits and manages appropriate amplification devices and assistive technologies (std II-E8, II-E9, II-E10, II-E11, II-E12, II-E13)
27
Score
28
Audiologic (Re)habilitation
7. Identifies and counsels individuals who are candidates for cochlear implantation and other implantable devices a (std II-E14, II-E15)
8. Provides programming and fitting adjustments, including postfitting counseling for cochlear implant clients/patients (std II-E16)
9. Identifies, selects and fits electroacoustically appropriate hearing assistive technology systems (HATS) based on clients’/patients’ communication, educational, vocational, and social needs when
conventional amplification is not indicated or provides limited benefit (std II-E17, II-E18, II-E19, II-E20)
10. Provides auditory, visual, and auditory–visual communication training (e.g., speechreading, auditory training, listening skills) to enhance receptive communication (std II-E21)
11. Manages/treats tinnitus appropriately and assesses efficacy of interventions (std II-E22, II-E23, II-E24, II-E25; std 3.1.6A-8, 3.1.6A-14)
12. Provides canalith repositioning for patients diagnosed with benign paroxysmal positional vertigo (BPPV) (std II-E26)
13. Provides intervention for central and peripheral vestibular deficits (std II-E27)
14. Selects and uses outcomes measures that are valid and reliable indicators of success in determining the impact of the interventions used to minimize the effects of changes in structure and function of the
auditory and vestibular systems (std 3.1.6A-19)
Pediatric Audiology (Re)habilitation Score
1. Selects appropriate amplification devices/HATS and instructs regarding use, care and maintenance in children (std II-F5, II-F6)
2. Counsels, educates and supports children and their parents/caregivers regarding hearing impairment (std II-F1, II-F2, II-F3, II-F4, II-F7, II-F11)
3. Provides intervention to ensure that speech and language development is age and developmentally appropriate (std II-F8)
4. Evaluates acoustics of classroom settings and provides recommendations for modifications in children (std II-F12)
5. Administers self-assessment, parental, and educational assessments to monitor treatment benefits and outcomes in children (std II-F9)
6. Provides ongoing support for children by participating in IEP or IFSP processes (std II-F10)
7. Provides interprofessional consultation and/or team management with speech-language pathologists, educators, and other related professionals regarding children served (std II-F13)
Counseling Score
1. Provides counseling based on client/patient/family needs (std II-D1, II-D2, II-D9; std 3.1.1A-14, 3.1.6A-5)
2. Facilitates effective communication and coping skills for patients, while addressing implications of hearing impairment and enhancing well-being and quality of life (std II-D5, II-D6)
3. Facilitates and enhances clients'/patients' and their families' understanding of, acceptance of, and adjustment to auditory and vestibular disorders, technologies and/or devices (std II-D3, II-D4)
4. Promotes clients’/patients’ self-efficacy beliefs and promotes self-management of communication and related adjustment problems (std II-D-7)
5. Enhances adherence to treatment plans and optimizes treatment outcomes (std II-D8)
Communication Score
1. Uses effective communication skills to ensure the highest quality of care is delivered in a culturally competent manner (std 3.1.1A-Effective Communication Skills-a/b)
2. Documents evaluation procedures and results, maintaining records consistent with legal and professional standards (std 3.1.4A-11, 3.1.6A-15)
3. Documents treatment procedures and results, maintaining records consistent with legal and professional standards (std 3.1.6A-16, 3.1.6A-17)
4. Communicates results, recommendations, and progress orally and in writing in a culturally sensitive and age-appropriate manner to the individual being served and other appropriate individual(s) (std
3.1.4A-16, 3.1.6A-13, 3.1.6A-18)

Professional Practice Score
1. Practices following the professional code of ethics / scope of practice documents and adheres to federal, state, and institutional regulations and policies (std 3.1.1A-Accountablility-a/b, 3.1.1A-Integrity-a/b,
3.1.1A-Professional Duty-e)
2. Uses self-reflection/self-assessment to understand the effects of his or her actions/improve effectiveness and make changes accordingly in the delivery of clinical services (std 3.1.1A-Accountability-e,
3.1.1A Professional Duty-a)
3. Facilitates and advocates for access to services (std 3.1.1A-Accountability-f, 3.1.1A-Professional Duty-b, 3.1.6A-12)
4. Uses sound clinical reasoning in all aspects of care (std 3.1.1A-Clinical Reasoning-a/b/c)
5. Makes clinical decisions based on evidence-based practice (std 3.1.1A-Evidence-Based Practice-a/b, 3.1.3A-8, 3.1.4A-19, 3.1.6A-15)
6. Delivers the highest quality of effective care with cultural competence (std 3.1.1A-Cultural Competence-a/b/c/d/e, 3.1.6A-6)
7. Understands collaborative practice (std 3.1.1A-Accountability-g, 3.1.1A-Professional Duty-d/f, 3.1.1A-Collaborative Practice, a/b, 3.1.4A-17)
8. Shows concern for individuals served (std 3.1.1A-Concern for Individuals Served-a/b)
9. Understands fiduciary responsibility for individuals served, models of delivery and the role of clinical teaching/supervision (std 3.1.1A-Accountability-c/d, 3.1.1A-Professional Duty-c)
29
Appendix C
30
CALIPSO
Cumulative Evaluation
Doe, Jane
Young Child (0-5)
Child (6-17)
Adult (18-64)
Older adult (65+)
Performance Rating Scale
1 - Unacceptable performance 4 - Acceptable Performance/ Minimal Support
2 - Needs Improvement in Performance/ Maximum Support 5 - Acceptable Performance/ Independent
3 - Moderately Acceptable Performance/ Moderate Support
Severity of Interprofessional (or Client(s)/Patient(s) Multicultural Client(s)/Patient(s) Linguistic Cultural and Linguistic Variables (check all that
Within Normal Audiologist Ethnicity English Age
Mild Dentist Race English Language Learner Bilingual/Multilingual
Moderate Dietitian Culture Primary English dialect d/Deaf and Hard of Hearing
Severe Family Member National origin Secondary English dialect Disability
Nurse/Nurse Practitioner Socioeconomic status Bilingual Ethnicity
Occupational Therapist Gender identity Polyglot Gender Expression
Pharmacist Sexual orientation Gender identity Gender Identity
Physical Therapist Religion Sign Language (ASL or SEE) National Origin
Physician Exceptionality Cognitive / Physical Ability Non-Verbal Language
Physician Assistant Other Other Race
Psychologist/School Psychologist Religion
Recreational Therapist Sex
Respiratory Therapist Sexual orientation
Social Worker Verbal Language
Special Educator Veteran Status
Teacher (classroom, ESL, Other
Vocational Rehabilitation
Other
Evaluation Skills Speech Sound Fluency Voice Language Hearing Swallowing Cognition Social Aspects AAC
Production
1. Conducts screening and prevention procedures, including prevention activities Pass ! ! ! ! ! ! ! !
(CFCC V-B, 1a)
2. Demonstrates current knowledge of the principles and methods of prevention ! ! ! ! ! ! ! ! !
and assessment, including consideration of anatomical/physiological,
psychological, developmental, and linguistic and cultural correlates (CFCC IV-D)
3. Collects case history information and integrates information from ! ! ! ! ! ! ! ! !
clients/patients, family, caregivers, teachers, and relevant others, including other
professionals (CFCC V-B, 1b)
4. Selects appropriate evaluation instruments/procedures (CFCC V-B, 1c) ! ! ! ! ! ! ! ! !
Page 1/3 * August 29 2022 +00:00 * Cumulative Evaluation

Professional Practice, Interaction and Personal Qualities Score
1. Demonstrates knowledge of basic human communication and swallowing processes. Demonstrates the ability to integrate information pertaining to normal and abnormal human development across the life Pass
span (CFCC IV-B; CAA 3.1.6B)
2. Demonstrates knowledge of processes used in research and integrates research principles into evidence-based clinical practice (CFCC IV-F; CAA 3.1.1B Evidenced-Based Practice) !
3. Demonstrates knowledge of contemporary professional issues that affect Speech-Language Pathology (CFCC IV-G; CAA 3.1.1B) !
4. Demonstrates knowledge of entry level and advanced certifications, licensure, and other relevant professional credentials, as well as local, state, and national regulations and policies relevant to professional !
practice (CFCC IV-H)
5. Communicates effectively, recognizing the needs, values, preferred mode of communication, and cultural/linguistic background of the individual(s) receiving services, family, caregivers, and relevant others !
(CFCC V-B, 3a; CAA 3.1.1B Effective Communication Skills, CAA 3.1.6B)
6. Provides counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others (CFCC V-B, 3c; CAA 3.1.6B) !
7. Manages the care of individuals receiving services to ensure an interprofessional, team-based collaborative practice (CFCC V-B, 3b; CAA 3.1.1B) !
8. Demonstrates skills in oral and other forms of communication sufficient for entry into professional practice (CFCC V-A) !
9. Demonstrates skills in written communication sufficient for entry into professional practice (CFCC V-A) !
10. Demonstrates knowledge of standards of ethical conduct, behaves professionally and protects client welfare (CFCC IV-E, V-B, 3d; CAA 3.1.1B-Accountability; 3.8B) !
11. Demonstrates an understanding of the effects of own actions and makes appropriate changes as needed (CAA 3.1.1B - Accountability) !
12. Demonstrates professionalism (CAA 3.1.1B - Professional Duty, 3.1.6B) !
Met Not Not Met/Not Met

Met Marked
1 1 1. Demonstrates openness and responsiveness to clinical supervision and suggestions
2 2. Personal appearance is professional and appropriate for the clinical setting
1 1 3. Displays organization and preparedness for all clinical sessions
1 1 4. Practices the principles of universal precautions to prevent the spread of infectious and contagious diseases (CAA 3.8B)
1 1 5. Differentiates service delivery models based on practice sites (e.g., hospital, school, private practice) (CAA 3.1.1B - Accountability)
1 1 6. Explains healthcare landscape and how to facilitate access to services in the healthcare sector (CAA 3.1.1B - Accountability)
1 1 7. Explains educational landscape and how to facilitate access to services in the educational sector (CAA 3.1.1B - Accountability)
1 1 8. Identifies and acknowledges the impact of both implicit and explicit bias in clinical service delivery and actively explores individual biases and how they relate to clinical
services (CAA 3.4B)
1 1 9. Identifies and acknowledges the impact of how their own set of cultural and linguistic variables affects clients/patients/students' care (CAA 3.4B)
1 1 10. Identifies and acknowledges the impact cultural and linguistic variables of the individual served may have on delivery of effective care (CAA 3.4B)
1 1 11. Identifies and acknowledges the interaction of cultural and linguistic variables between caregivers and the individual served (CAA 3.4B)
1 1 12. Identifies and acknowledges the social determinants of health and environmental factors for individuals served and how these determinants relate to clinical services (CAA
3.4B)
1 1 13. Identifies and acknowledges the impact of multiple languages. Explores approaches to address bilingual/multilingual individuals requiring services, including
understanding the difference in cultural perspectives of being d/Deaf and acknowledge Deaf cultural identities. (CAA 3.4B)
1 1 14. Recognizes that cultural and linguistic diversity exists among various groups (including d/Deaf and hard of hearing individuals) and fosters the acquisition and use of all
languages (verbal and nonverbal), in accordance with individual priorities and needs (CAA 3.4B)
1 1 15. Engages in self-assessment to improve effectiveness in the delivery of clinical services (CAA 3.1.6B)
31
32
Evaluation Skills Speech Sound Fluency Voice Language Hearing Swallowing Cognition Social Aspects AAC
Production
5. Administers non-standardized and standardized tests correctly (CFCC V-B, 1c) ! ! ! ! ! ! ! ! !
6. Adapts evaluation procedures to meet the needs of individuals receiving services ! ! ! ! ! ! ! ! !
(CFCC V-B, 1d)
7. Demonstrates knowledge of communication and swallowing disorders and ! ! ! ! ! ! ! ! !
differences (CFCC IV-C)
8. Interprets, integrates, and synthesizes all information to develop diagnoses ! ! ! ! ! ! ! ! !
(CFCC V-B, 1e)
9. Interprets, integrates, and synthesizes all information to make appropriate ! ! ! ! ! ! ! ! !
recommendations for intervention (CFCC V-B, 1e)
10. Completes administrative and reporting functions necessary to support ! ! ! ! ! ! ! ! !
evaluation (CFCC V-B, 1f)
11. Refers clients/patients for appropriate services (CFCC V-B, 1g) ! ! ! ! ! ! ! ! !
Treatment Skills Speech Sound Fluency Voice Language Hearing Swallowing Cognition Social Aspects AAC
Production
1. Develops setting-appropriate intervention plans with measurable and achievable Pass ! ! ! ! ! ! ! !
goals that meets client/patient needs, demonstrating knowledge of the principles of
intervention and including consideration of anatomical/physiological,
developmental, and linguistic cultural correlates. Collaborates with clients/patients
and relevant others in the planning process (CFCC IV-D, V-B, 2a)
2. Implements intervention plans that involve clients/patients and relevant others in ! ! ! ! ! ! ! ! !
the intervention process (CFCC V-B, 2b)
3. Selects or develops and uses appropriate materials and instrumentation (CFCC ! ! ! ! ! ! ! ! !
V-B, 2c)
4. Measures and evaluates clients'/patients' performance and progress (CFCC V-B, ! ! ! ! ! ! ! ! !
2d)
5. Modifies intervention plans, strategies, materials, or instrumentation to meet ! ! ! ! ! ! ! ! !
individual client/patient needs (CFCC V-B, 2e)
6. Completes administrative and reporting functions necessary to support ! ! ! ! ! ! ! ! !
intervention (CFCC V-B, 2f)
7. Identifies and refers patients for services as appropriate (CFCC V-B, 2g) ! ! ! ! ! ! ! ! !
Additional Clinical Skills Score
1. Sequences tasks to meet objectives Pass

2. Provides appropriate introduction/explanation of tasks !
3. Uses appropriate models, prompts or cues. Allows time for patient response. !
4. Demonstrates effective behavior management skills !
5. Practices diversity, equity and inclusion (CAA 3.4B) !
6. Addresses culture and language in service delivery that includes cultural humility, cultural responsiveness, and cultural competence (CAA 3.4B) !
7. Demonstrates clinical education and supervision skills. Demonstrates a basic understanding of and receives exposure to the supervision process. (CAA 3.1.6B) !
Appendix D
PRACTICUM PLANNING FALL 2023
The following are fall practicum planning instructions for all 1st year SLP students and 1st and 2nd
year audiology students on CALIPSO.
Dr. Barbara Jacobson and Dr. Fino-Szumski cannot begin scheduling clinic assignments until everyone
has completed fall class registration and we have an e-mail from each student regarding practicum
planning.
To facilitate FALL practicum scheduling, please do the following:
Send an e-mail with the subject line “Practicum Planning Fall 2023 for YOUR NAME” no later than July
31, 2023 to the designated person below:
• Speech Pathology Students: Dr. Barbara Jacobson
• Audiology Students: Dr. Mary Sue Fino-Szumski
Cut and paste the following into the e-mail with your replies to the questions:
Considerations for scheduling:
NOTE: It is assumed that all students have transportation.
_____ I have met all of training grant stipend support commitments.

_____ I have not met my training grant stipend support commitments; describe
Other comments:
• Specify any personal or other concerns that could potentially be taken into consideration with
practicum scheduling.
• Specify any need for clock hours in a specific area of practice/setting/population for placement for
next semester.
SPECIAL NOTE: The start date for fall clinic assignments will be Monday, August 28.
Thank you for your attention to these matters and thank you for your help in completing another
successful semester as well as the necessary documentation for your clinical records.
Please let me know if you have questions.
33
Appendix E
Appendix E
CALIPSO AUDIOLOGY CLOCK HOURS
34
Appendix F
Appendix F
CALIPSO M.S.-SLP CLOCK
35
Appendix G
36
Appendix G
Vanderbilt University (Au.D.)
CALIPSO
Supervisor Feedback by Doe, Jane
Printed for
Doe, Jane
Supervisor Feedback by Doe, Jane

Student: Doe, Jane
This feedback has been approved and is available to the supervisor.
* Supervisor: Graduate Supervisor,
* Site: Undergraduate University
* Semester: 2018 Spring
1. Provided an orientation to the facility and caseload.
No orientation provided. Student Formal orientation provided with

N/A Informal orientation provided.
oriented him/herself. supplemental documentation.
2. Provided the student with feedback regarding the skills used in diagnostics.
Comments were vague; and therefore, Comments were useful but lacked Comments were useful, specific, and
N/A
difficult to apply. specifics or concrete examples. constructive.
3. Provided the student with feedback regarding the skills used in interviewing.
N/A
4. Provided the student with feedback regarding the skills used in conferences.
N/A
5. Provided the student with feedback regarding the skills used in behavioral management.
N/A
1/4
9/11/2020 Supervisor Feedback by Doe, Jane | CALIPSO
6. Provided the student with feedback regarding the skills used in therapy.
N/A
7. Provided the student with feedback regarding his/her selection of diagnostic or therapy materials.
N/A
8. Explained and/or demonstrated clinical procedures to assist student in clinical skills development.
Provided thorough explanations and/or

Provided minimal explanations and/or Provided adequate explanations and/or
N/A demonstrations for all clinical
demonstrations. demonstrations when requested.
procedures.
9. Utilized evidence-based practice.
Occasionally referenced current

N/A Rarely referenced current literature. Frequently referenced current literature.
literature.
10. Encouraged student independence and creativity.
Somewhat receptive to new ideas and

Minimally receptive to new ideas and Very receptive to new ideas and
N/A differing techniques but did not
differing techniques. encouraged use of own techniques.
encourage them.
11. Provided positive reinforcement of student's successes and efforts.
Rarely commented on successes and Occasionally commented on successes Frequently commented on successes
N/A
efforts. and efforts. and efforts.
12. Provided student with written and/or verbal recommendations for improvement.
Rarely provided written and/or verbal Occasionally provided written and/or Systematically provided written and/or
N/A recommendations except on midterm verbal recommendations in addition to verbal recommendations in addition to
and final evaluations. the midterm and final evaluations. the midterm and final evaluations.
13. Demonstrated enthusiasm and interest in the profession and in providing clinical services.
Enthusiasm and interest occasionally Enthusiasm and interest regularly

Enthusiasm and interest rarely
N/A observed; occasional negative observed; frequent positive and
observed; frequent negative comments.
comments. optimistic comments.
14. Demonstrated effective interpersonal communication with student.
37
2/4
N/A Seemed uninterested and/or unwilling Some interest in student's needs Aware of and sensitive to student's
38
to listen or respond to student's needs. shown, but communication lacked needs; open and effective
sensitivity. communication.
15. Receptive to questions.
Answered questions with helpful

Unwilling to take time to answer information or additional resources
N/A Answered questions inconsistently.
questions. which encouraged me to think for
myself.
16. Available to me when I requested assistance.
N/A Supervisor was rarely available. Supervisor was occasionally available. Supervisor was always available.
17. Utilized effective organizational and management skills.
Rarely organized; showed difficulty Somewhat organized; balanced Always organized; balanced
N/A balancing supervisory and clinical supervisory and clinical responsibilities supervisory and clinical responsibilities
responsibilities. with little difficulty. with ease.
18. Referred me to or provided me with additional resources (materials, articles, video tapes, etc.)
Provided minimal or no additional Provided helpful resources upon Provided helpful resources without
N/A
resources. student request. student request.
19. Realistically demanding of me as a student intern.
Expectations were either too high or too Expectations were individualized and
Expectations were generally
N/A low for level of experience with no adjusted according to my strengths and
appropriate for my level of experience.
attempts to adjust. weaknesses.
Overall, how would you rate this clinical experience?
Additional comments?
test
What experience during this practicum provided you with the greatest learning
opportunity
test
3/4
This feedback has been approved and is available to the supervisor.
Authored by: Laurel H. Hays, M.Ed., CCC-SLP and Satyajit P. Phanse, M.S. © 2010 Calipso, LLC
39
4/4
Vanderbilt University (AUD) Appendix H
Appendix H
40
CALIPSO
Off-campus Placement Evaluations
Printed for
Doe, Jane
Off-campus Placement Evaluations

Site: Semester:
Using the following scale, rate your agreement: N/A 1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
OVERALL
This practicum experience met my training goals and interests

1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree
This practicum experience met expectations regarding clinical population, workload, and documentation
The site furthered my efforts to achieve my professional goals

The site provided a reasonable balance between direct clinical contact hours vs. related clinical responsibilities
There were opportunities to discuss the process of ethical decision making

Evidence-based clinical practice was utilized

In general, I felt welcomed at this site

I felt prepared to meet the challenges and expectations of this practicum site
I would recommend that this site be used for future practicum placements
THE PRACTICUM SITE PROVIDED ADEQUATE:
Supervision by clinical supervisor

Training and orientation

https://www.calipsoclient.com/audiology/vanderbilt/offcampus_placement_evals/new 1/3
9/11/2020 Off-campus Placement Evaluations | CALIPSO
Physical facilities and work space
Equipment and materials to engage in effective service delivery

Administrative/clerical support
THE PRACTICUM SITE ALLOWED APPROPRIATE OPPORTUNITIES FOR:
Diagnostic experiences
Treatment
Client and family interactions

Interactions with other professionals

Interactions with culturally and linguistically diversified populations

PROVIDE COMMENTS ON THE FOLLOWING:
What were the strengths/positive aspects of this practicum site?
What might you suggest to strengthen the experience at this practicum site?
What advice would you give the next student placed at this site?
41
https://www.calipsoclient.com/audiology/vanderbilt/offcampus_placement_evals/new 2/3
Appendix
AppendixII
New PPE Guidelines FAQs

Effective July 20, 2020 healthcare personnel must wear eye protection and
surgical/procedural masks with direct, prolonged patient interactions.
Frequently Asked Questions
Who must wear eye protection and surgical masks?
Anyone entering a patient-occupied clinic exam or hospital room or having direct, prolonged (>5 min) contact with a
patient. This guidance does not replace recommended PPE for other specific isolation precautions.
Can I reuse the surgical mask and eye protection between patients?
Yes, with a few exceptions. The surgical mask and eye protection must be worn across multiple patient encounters
without disposal. Surgical masks must be discarded if they become wet, torn, or soiled. Eye protection must be cleaned
if they become contaminated or soiled. When exiting a contact or droplet precaution room, masks must be discarded
and eye protection cleaned.
When must a cloth mask be worn?

Anyone not providing direct, prolonged patient care and not entering patient rooms must wear a cloth mask.
A cloth mask must be worn outside of patient care areas including the cafeterias, parking garages, hallways,
administrative offices, and by valet.
What is considered “eye protection”?

Eye protection includes goggles, face shields, mask/splashguard, safety glasses, or shields that clip onto the sides of
personal eyeglasses. Personal eyeglasses alone are not considered adequate eye protection.
Do I still need to wear eye protection and a surgical mask if a patient has tested negative for SARS-CoV-2?
Yes.
What led to the change in PPE recommendations?

If persons to whom you are exposed are wearing masks, then their respiratory droplets will be contained by their mask;
however, patients are not always fully compliant with wearing masks properly. Though SARS-CoV-2 spreads primarily
through a respiratory route, it is possible the virus could land in the eye and lead to infection even if your mouth and
nose are covered by a mask. Rates of COVID-19 community transmission are increasing in our region, and CDC has
recently recommended the addition of eye protection in this setting.
How do I clean my eye protection?

Do not touch your eye protection during direct patient care. If your eye protection becomes contaminated or soiled,
promptly remove, wipe down with hospital approved disinfectant, and allow to air dry. Store your eye protection in a
bag, labeled with your name, and continue to use across multiple shifts while in good condition.
How do I store my surgical mask?

Do not touch your surgical mask during direct patient care. If your mask becomes wet, torn, or soiled, remove your mask
holding the straps and discard. Store your mask by folding it in half in a brown bag, labeled with your name, and
continue to use across multiple shifts while in good condition.
How do we obtain PPE?

Supplies will be available in outpatient clinics and inpatient floors.
07/16/2020 Department of Infection Prevention – Resource
42
Appendix
AppendixII
Personal Protective Equipment (PPE)

Updates and Reminders
Personal protective equipment (PPE) is recommended to be worn to reduce the risk of contamination and germ
dissemination. Masks, gowns, gloves, and eye protection are all PPE components that when used appropriately provide
protection to everyone at VUMC.
Surgical/procedure masks must be worn at all times in any clinical areas of VUMC.
Eye protection must be worn by any personnel entering patient-occupied clinic
exam/hospital rooms for any length of time regardless of COVID test results OR in other
locations where the individual will have direct, prolonged (>5 min) contact with a patient
Masks should be worn at all times, this guidance applies to everyone at VUMC. The type of mask will depend on the
environment and situation. Eye protection should be worn in all patient rooms, regardless of time spent with the
patient.
It is important to note that PPE stocks continue to be secured to maintain a good supply; however, we should all do our
part to prevent PPE waste. PPE must be worn according to Standard and CDC Isolation Precautions. Below are answers
to Frequently Asked Questions with some examples on how to best optimize our PPE supplies.

Why is Eye Protection Recommended for All Patient Interactions?”
If persons to whom you are exposed are wearing masks, then their respiratory droplets will be contained by their mask;
however, patients are not always fully compliant with wearing masks properly. Though SARS-CoV-2 spreads primarily
through a respiratory route, it is possible the virus could land in the eye and lead to infection even if your mouth and
nose are covered by a mask. Rates of COVID-19 community transmission are increasing in our region, and the CDC has
recommended the addition of eye protection in patient care settings/situations.
Where is Masking Required?

Masking is required in all areas of VUMC (including all clinical, non-clinical, research and public areas). This includes
common public areas such as cafeteria/food courts, break rooms, research labs, conference rooms, bathrooms,
elevators, and waiting rooms.
Masks should be worn while walking outdoors to and from VUMC buildings from parking areas, from the time of
entering or exiting one’s car. Masks may be removed ONLY if a person is sitting in their assigned workspace (e.g. office,
cubicle, lab bench desk) AND can maintain at least 6 feet distance from all others.
12/2/2020, v.3 Department of Infection Prevention – Resource
43
What Type of Mask Should be Worn?
• Non-clinical, Research, and Public Areas: Wear a paper mask or cloth face covering
• Clinical Areas where one enters a patient room or has prolonged (>5 mins), direct patient contact: Wear a
surgical/procedural mask and eye protection (see Eye Protection & Surgical Mask)
• Other Clinical Areas/Situations: Wear a surgical/procedural mask.
• N95 respirators should NOT be worn in general clinical areas or for non-approved indications. For additional
information refer to the N95 Reminders document.
Why are we recommending a procedure/surgical or cloth mask and not an N95 respirator?
Similar to influenza and other respiratory viruses, COVID-19 appears to be transmitted primarily through large
respiratory droplets. Surgical/procedure masks provide protection against respiratory droplet spread. In contrast, N95
respirators provide a higher level of filtration and are important in clinical situations where infectious particles could
become aerosolized. This primarily occurs in specific clinical situations such as when a patient is intubated or undergoes
bronchoscopy. N95 respirators are also difficult to wear for long periods of time. As the N95 respirator supply must be
reserved for approved high-risk procedures, N95 respirators should NOT be worn in general clinical areas or for non-
approved indications.
What is the difference between a surgical and a procedural mask?

Both provide bacterial, particle, and pathogen filtration at comparable levels. Surgical masks, however, have a higher
degree of impermeability to prevent blood/body fluid exposures one would anticipate in a surgical setting.
How can I eat/drink when I am supposed to wear a mask?

Perform hand hygiene, remove the mask, eat or drink in an approved location, and then replace your mask. Please
follow the guidelines on appropriate doffing and maintain social distancing (e.g. space out in break rooms, at dining
tables).
What if I feel like I cannot wear a mask?

You can request a medical accommodation through Employee Relations at [email protected] or you
can call 615-343-4759 if you have questions. The following link provides information about the accommodation process
https://hr.vumc.org/Employee-Relations/Accommodations.
Can masks or N95 respirators that have an external valve or vent (see picture) be used as
part of universal masking at VUMC?
No. These types of masks do not protect others if the wearer has COVID-19 infection, and
they are not permitted by CDC guidelines. The external valves/vents are designed to release
unfiltered air and do not effectively remove the virus from exhaled breath in the event the
wearer has COVID-19 infection. This vent does not impair the device’s filtration of inhaled
air when worn as personal protective equipment to protect the wearer. For VUMC:
• A face mask with an external valve/vent should not be used. If any workforce member, patient, or visitor does
not have a mask without a valve/vent, one will be provided to them.
• A VUMC provided N95 respirator with an external valve/vent should only be used if no other N95s are available,
and, if used, a surgical mask should be worn over the vented N95.
44
What if I experience a burning sensation or skin irritation while wearing an N95 mask?
If you notice this type of discomfort from any PPE use, remove yourself from patient care, take off the PPE, fill out a
VERITAS Report, and call Occupational Health for further instructions.
Who must wear eye protection with surgical masks?

• Anyone entering a patient-occupied clinic exam or hospital room for any length of time regardless of COVID test
results.
• Anyone in other locations having direct, prolonged (>5 min) contact with a patient (i.e. outside of a patient room
such as in the hallway, ancillary testing).
• This guidance does not replace recommended PPE for other specific isolation precautions.
Yes, with a few exceptions. The surgical mask and eye protection must be worn across multiple patient encounters
without disposal. Surgical masks must be discarded if they become wet, torn, or soiled. Eye protection must be cleaned
if it becomes contaminated or soiled. When exiting a contact or droplet precaution room, masks must be discarded and
eye protection cleaned. Staff should use a dedicated set of eye protection and should not share their eye protection
with anyone else.
How do I store my surgical mask?

Do not touch your surgical mask during direct patient care. Store your mask by folding it in half (clean interior sides
together), place in a paper bag, labeled with your name. Continue to use across multiple shifts while in good condition. If
your mask becomes wet, torn, or soiled, remove your mask holding the straps and discard.
What is considered “eye protection?”

Eye protection includes goggles, face shields, mask with splashguard, safety glasses, or shields that clip onto the sides of
personal eyeglasses. Personal eyeglasses alone are not considered adequate eye protection.
Why are patients not required to wear eye protection?

Healthcare personnel have more interactions with individual patients who are sometimes unable to wear a mask due to
intolerance or a need to remove the mask for patient care examinations; therefore, additional PPE is used by healthcare
personnel. Patients do not have the same amount of interactions and will be protected from spread by the universal use
of surgical masks and eye protection by our healthcare personnel.
How do I clean my eye protection?

Do not touch your eye protection during direct patient care. If your eye protection becomes contaminated or soiled,
promptly remove, wipe down with hospital approved disinfectant, and allow to air dry. Perform hand hygiene. Store
your eye protection in a bag, labeled with your name, and continue to use across multiple shifts while in good condition.
How do we obtain PPE?

Supplies are available in outpatient clinics and inpatient areas. You can be request PPE through the area leadership
teams or staffing leaders.
45
If my patient is in a double occupancy COVID + room, how does that change PPE use?
• Don PPE and provide care for patient #1
• At the end of that care, doff gloves, perform hand hygiene, don new gloves and provide care to patient #2.
• For dedicated COVID units, follow “Cohorting PPE Guidelines” remembering to change all PPE after 4 patient
encounters (not 4 rooms).
If my patient is in a double occupancy COVID - room, how does that change PPE use?
• Don PPE (mask and eye protection) and provide care for patient #1
• At the end of patient #1’s care, perform hand hygiene, and provide care to patient #2.
• When exiting the room, your masks can remain on unless damp, soiled or damaged.
• Eye protection is cleaned if soiled or contaminated.
When should someone wear a nitrile glove instead of a vinyl glove? Is there a difference?
Vinyl gloves provide standard barrier protection from COVID-19, are soft and comfortable, and are latex and powder
free, whereas nitrile gloves are chemical and puncture resistant and have a higher degree of tactile sensation for
sensitive work such as starting IVs.
There are patient encounters where vinyl gloves are a suitable and safe option, including transport, valet, guest services,
and EVS. These departments have been asked to utilize vinyl gloves to help us use our nitrile glove supply properly going
forward and ensure the safety of everyone.
When should gloves be worn?

Medical gloves are recommended to be worn to reduce the risk of contamination of healthcare workers hands when
blood and other body fluids are present. Wearing gloves also reduces the risk of germ dissemination.
Gloves should therefore be used during all patient-care activities that may involve exposure to blood and all other body
fluid (including contact with mucous membrane and non-intact skin) and for patients on contact precautions.
Gloves must be worn according to Standard and Contact Precautions. The pyramid below describes situations when
sterile and examination gloves should be worn and when gloves are not necessary. It is important that gloves are never
reused between two patient encounters and are changed when they become soiled or torn.
46
47
AppendixJJ
Appendix
EYE Protection
& Surgical mask
Eye Protection & Surgical Mask Reminders
When to wear eye protection & surgical masks

Anyone entering a patient-occupied clinic exam or hospital room or having direct, prolonged (>5 min) contact
with a patient. This guidance does not replace recommended PPE for other specific isolation precautions.
Yes, with a few exceptions. The surgical mask and eye protection should be worn across multiple patient
encounters without disposal. Surgical masks should be discarded if they become wet, torn, or soiled. Eye
protection should be cleaned if they become contaminated or soiled. When exiting a contact or droplet
precaution room, masks should be discarded and eye protection cleaned.
Eye protection reminders (prescription or reader eyeglasses are not proper protection)
• Do not touch during direct patient care.
• Clean with a hospital approved disinfectant if it becomes contaminated or soiled.
• Wear while in good condition.
• Store and wear across multiple shifts.
• After entering the room of a patient on contact or droplet precautions, clean your eye protection.
Surgical mask reminders

• Do not touch during patient care.
• Discard if the mask is wet, torn, or soiled.
• Wear while in good condition.
• Store in a brown paper bag after use.
• Wear across multiple shifts.
• Change if conducting a sterile procedure (e.g. in the OR).
• Change after entering the room of a patient on contact or droplet precautions.
For COVID-19 information, go to vumc.org/coronavirus.

7/16/2020
HR LP&I
48
Masking and Workplace Guidance
Updated May 31, 2022
All people must wear a mask while in public indoor areas on

Vanderbilt University Medical Center campus.
Everyone is required to wear a mask, regardless of vaccination status, in all

indoor areas of VUMC that are public, including non-clinical locations,
hallways, elevators, and on VUMC shuttles.
Masks are not required outdoors.
Masks may be removed/not worn in public areas:
• when alone.
• when eating and drinking. (Note: People who are not vaccinated
should avoid eating and drinking with others indoors.)
When a person is unable to wear a face mask due to a medical necessity,
medical condition or disability, a face shield should be worn.
Clear masks may be worn with patients who are hearing impaired or
rely on reading lips to communicate, unless when caring for a known or
suspected COVID-19 patient.
When caring for a known or suspected COVID-19 patient:

wear an N95 (or PAPR), eye protection, gown and gloves.
Staff in all other clinical areas

Wear a surgical or procedural mask.
Patients and visitors, and staff in a non-clinical area

Wear any mask.
Masks must cover both the mouth and nose.
For detailed guidance, go to vumc.org/coronavirus.

5/31/2022 (HR LP&I)
49
Appendix
AppendixKK
Required Masking of All VUMC Personnel

(in Clinical, Non-Clinical, Research and Public Areas)
Rationale for Universal Masking Guidance
Our knowledge regarding COVID-19 is rapidly expanding. This allows us the opportunity to update PPE policies to
incorporate the best evidence about issues like masking. Given what we have learned about COVID-19, universal
masking, in addition to social distancing and frequent hand hygiene, will help prevent spread secondary to pre-
symptomatic or asymptomatic infection.
To be successful, this approach will require support from all of us across the enterprise and will require the following:
• Strict adherence to extended use/reuse of masks
• Meticulous adherence to hand hygiene (including before and after touching or removing masks)
• Proper mask use and hygiene including wearing the mask as directed to cover the mouth and nose
• Strict avoidance of manipulation/touching the mask to reduce the risk of contamination
Where is Masking Required?

Masking is required in all areas of VUMC (including all clinical, non-clinical, research and public areas). This includes
common public areas such as cafeteria/food courts, break rooms, research labs, conference rooms, bathrooms,
elevators, and waiting rooms.
Masks should be worn while walking outdoors to and from VUMC buildings from parking areas, from the time of
entering or exiting one’s car. Masks may be removed ONLY if a person is sitting in their assigned workspace (e.g.
office, cubicle, lab bench desk) AND can maintain at least 6 feet distance from all others.
What Type of Mask Should be Worn?

• In non-clinical, research, and public areas: Wear a paper mask or cloth face covering
• In clinical areas where one enters a patient room or has prolonged (>5 mins), direct patient contact: Wear a
surgical/procedural mask and eye protection (see Eye Protection & Surgical Mask)
• In all other clinical areas/situations: Wear a surgical/procedural mask.
As our current N95 respirator supply must be reserved for approved high-risk procedures, N95 respirators
should NOT be worn in general clinical areas or for non-approved indications. N95 Reminders
DO: DO NOT:
• Wear masks in all VUMC areas as noted • Wear N95 respirators unless performing an
• Follow guidance on reuse, donning and doffing approved high-risk procedure
• Conserve masks • Wear or store masks incorrectly
• Wear and store masks correctly
50
Process to Obtain Masks
Supply Chain will provide clinical areas with the appropriate masks. Masks will be issued by the clinical manager.
Stock will be securely stored in each clinical setting. Should you need a replacement mask, you must request one
from supervisory personnel in your clinical area. All personnel should make every effort to help preserve the supply
of PPE and reduce the need for replacement masks whenever possible. Masks should not be diverted to persons
outside VUMC.
Mask Reuse
In order to conserve masks, procedure/surgical masks should be used throughout the shift/day and should be
reused each day. Surgical masks should be replaced once they become visibly soiled, damp or damaged. Cloth
masks should be laundered each night at home and replaced when damaged or torn.
Guidance on Procedure/Surgical and Cloth Mask Use and Reuse

To remove mask:
1. Perform hand hygiene
2. Remove mask
• Ear-Loop Mask Style: Remove mask by holding the ear loops. The front is contaminated, so remove
slowly and carefully.
• Tie Back Mask Style: Remove mask by untying lower tie FIRST. Untie upper tie last. The front is
contaminated, so remove slowly and carefully. Ensure ties do not fall into clean interior side of mask.
• Behind the Head Elastic Strap Style: Grasp both elastic straps at side of head. Pull mask away from face,
then pull straps from back of head. The front is contaminated, so remove slowly and carefully. Ensure
bands do not fall into clean interior side of mask.
3. After removing mask, visually inspect for contamination, distortion in shape/form. If soiled, torn, or
saturated, procedure/surgical masks should be discarded. If torn or damaged, cloth masks should be
discarded.
4. If the mask is to be reused, carefully store in a bag, by folding the mask in half (clean interior sides
together) and place in a bag labelled with your name.
5. Perform hand hygiene.
To re-apply a used mask (that has not been laundered):

2. Grasp mask
• Pinch mask at the ear loops or grasp upper ties
3. Place over face
• For ear-loop style mask: Secure ear loops behind the ears. Secure mask.
• For tie back style mask: Secure upper ties first, behind head. End by securing lower ties behind head.
• For full head elastic band style: Stretch elastic bands at side of mask, secure both elastic bands to back
of head, then guide mask onto face.
51
Why are we recommending a procedure/surgical or cloth mask and not an N95 respirator?
Similar to influenza and other respiratory viruses, COVID-19 appears to be transmitted primarily through large
respiratory droplets. Procedure masks provide protection against respiratory droplet spread. In contrast, N95 respirators
provide a higher level of filtration and are important in clinical situations where infectious particles could become
aerosolized. This primarily occurs in specific clinical situations such as when a patient is intubated or undergoes
bronchoscopy. N95 respirators are also difficult to wear for long periods of time. As the N95 respirator supply must be
reserved for approved high-risk procedures, N95 respirators should NOT be worn in general clinical areas or for non-
approved indications.
Does this guidance apply to every member of the workforce?

Yes, this guidance applies to everyone at VUMC.
How can I eat/drink when I am supposed to wear a mask?

Perform hand hygiene, remove the mask, eat or drink in an approved location, and then replace your mask. Please
follow the guidelines on appropriate doffing and maintain social distancing (e.g. space out in break rooms, at dining
tables).
What if I feel like I cannot wear a mask?

You can request a medical accommodation through Employee Relations at [email protected] or you
can call 615-343-4759 if you have questions. The following link provides information about the accommodation process
https://hr.vumc.org/Employee-Relations/Accommodations.
52
CALIPSO
Knowledge And Skills Acquisition (KASA) Summary Form
Doe, Jane
2020 CFCC Standards (AUD)
Standards Knowledge/Skill Course # and Title Practicum Experiences # and Title Other (e.g. labs, research) (include
Met? (check) descriptions of activity)
Scientific and Research Foundations
• The basic sciences X AUD 5227, AUD 5233, AUD 5238, AUD 5310, AUD 5328, AUD 5346,
AUD 5310, AUD 5328, AUD 5332, AUD 5354, AUD 5359
AUD 5346, AUD 5354, AUD 5359
• Basic science skills (e.g., scientific methods, critical X AUD 5227, AUD 5233, AUD 5238, AUD 5310, AUD 5328, AUD 5346,
thinking) AUD 5310, AUD 5328, AUD 5332, AUD 5347, AUD 5354, AUD 5359
AUD 5337, AUD 5346, AUD 5347,
AUD 5354, AUD 5359
• The basics of communication sciences (e.g., acoustics, X AUD 5227, AUD 5233, AUD 5310, AUD 5310, AUD 5328, AUD 5340,
psychoacoustics and neurological processes of speech, AUD 5328, AUD 5337, AUD 5339, AUD 5345, AUD 5353, AUD 5354,
language, and hearing) AUD 5345, AUD 5353, AUD 5354, AUD 5359
AUD 5359, SLP 5304
Standard II-A: Foundations of Practice
• A1. Genetics, embryology and development of the X AUD 5227, AUD 5233, AUD 5325, AUD 5325, AUD 5346
auditory and vestibular systems, anatomy and AUD 5332, AUD 5346
physiology, neuroanatomy and neurophysiology, and
pathophysiology of hearing and balance over the life
span
• A2. Effects of pathogens, and pharmacologic and X AUD 5227, AUD 5325, AUD 5332 AUD 5325
teratogenic agents, on the auditory and vestibular systems
• A3. Language and speech characteristics and their X AUD 5354, SLP 5304 AUD 5354
development for individuals with normal and impaired
hearing across the life span
• A4. Principles, methods, and applications of acoustics, X AUD 5310, AUD 5328, AUD 5345, AUD 5310, AUD 5328, AUD 5345,
psychoacoustics, and speech perception, with a focus on AUD 5354, AUD 5359 AUD 5354, AUD 5359
how each is impacted by hearing impairment throughout
the life span
• A5. Calibration and use of instrumentation according to X AUD 5310, AUD 5328, AUD 5346, AUD 5310, AUD 5328, AUD 5346,
manufacturers’ specifications and accepted standards AUD 5347, AUD 5353, AUD 5359 AUD 5347, AUD 5353, AUD 5359
53
Appendix L
Page 1/13 * March 05 2021 * KASA Summary Form * Doe, Jane

54
• A6. Standard safety precautions and X AUD 5291, AUD 5292, AUD 5293, AUD 5345, AUD 5346, AUD 5347,
cleaning/disinfection of equipment in accordance with AUD 5345, AUD 5346, AUD 5347, AUD 5353, AUD 5359
facility-specific policies and manufacturers’ instructions AUD 5353, AUD 5359
to control for infectious/contagious diseases
• A7. Applications and limitations of specific audiologic X AUD 5310, AUD 5325, AUD 5332, AUD 5310, AUD 5325, AUD 5340,
assessments and interventions in the context of overall AUD 5337, AUD 5339, AUD 5345, AUD 5345, AUD 5353, AUD 5354
client/patient management AUD 5353, AUD 5354, AUD 5361
• A8. Implications of cultural and linguistic differences, X AUD 5291, AUD 5292, AUD 5293, AUD 5310, AUD 5340, AUD 5345,
as well as individual preferences and needs, on clinical AUD 5310, AUD 5332, AUD 5339, AUD 5353, AUD 5354
practice and on families, caregivers, and other interested AUD 5345, AUD 5353, AUD 5354,
parties AUD 5361
• A9. Implications of biopsychosocial factors in the X AUD 5310, AUD 5332, AUD 5347, AUD 5310, AUD 5347
experience of and adjustment to auditory disorders and AUD 5361
other chronic health conditions
• A10. Effects of hearing impairment on educational, X AUD 5310, AUD 5328, AUD 5339, AUD 5310, AUD 5328, AUD 5340,
vocational, social, and psychological function throughout AUD 5354, AUD 5361 AUD 5354
the life span
• A11. Manual and visual communication systems and X AUD 5291, AUD 5292, AUD 5293
the use of interpreters/transliterators/translators
• A12. Effective interaction and communication with X AUD 5238, AUD 5291, AUD 5292, AUD 5310, AUD 5325, AUD 5340,
clients/patients, families, professionals, and other AUD 5293, AUD 5310, AUD 5325, AUD 5346
individuals through written, spoken, and nonverbal AUD 5332, AUD 5339, AUD 5346,
communication AUD 5361
• A13. Principles of research and the application of X AUD 5233, AUD 5238, AUD 5310, AUD 5310, AUD 5325, AUD 5328,
evidence-based practice (i.e., scientific evidence, clinical AUD 5325, AUD 5328, AUD 5337, AUD 5340, AUD 5345, AUD 5346,
expertise, and client/patient perspectives) for accurate AUD 5339, AUD 5345, AUD 5346, AUD 5353, AUD 5354
and effective clinical decision making AUD 5353, AUD 5354, AUD 5361
• A14. Assessment of diagnostic efficiency and treatment X AUD 5238, AUD 5310, AUD 5346, AUD 5310, AUD 5346, AUD 5347,
efficacy through the use of quantitative data (e.g., number AUD 5347, AUD 5353, AUD 5361 AUD 5353
of tests, standardized test results) and qualitative data
(e.g., standardized outcome measures, client/patient-
reported measures)
• A15. Client-centered, behavioral, cognitive, and X AUD 5325, AUD 5345, AUD 5347, AUD 5325, AUD 5345, AUD 5347
integrative theories and methods of counseling and their AUD 5361
relevance in audiologic rehabilitation
• A16. Principles and practices of X AUD 5238, AUD 5325, AUD 5339, AUD 5325, AUD 5340, AUD 5345,
client/patient/person/family-centered care, including the AUD 5345, AUD 5354, AUD 5361 AUD 5354
role and value of clients’/patients’ narratives, clinician
empathy, and shared decision making regarding treatment
options and goals
• A17. Importance, value, and role of interprofessional X AUD 5238, AUD 5291, AUD 5292, AUD 5310, AUD 5325, AUD 5340,
communication and practice in patient care AUD 5293, AUD 5310, AUD 5325, AUD 5345
AUD 5332, AUD 5339, AUD 5345,
AUD 5361

• A18. The role, scope of practice, and responsibilities of X AUD 5238, AUD 5291, AUD 5292, AUD 5310, AUD 5340, AUD 5346,
audiologists and other related professionals AUD 5293, AUD 5310, AUD 5332, AUD 5347, AUD 5354
AUD 5337, AUD 5339, AUD 5346,
AUD 5347, AUD 5354, AUD 5361
• A19. Health care, private practice, and educational X AUD 5291, AUD 5292, AUD 5293, AUD 5310, AUD 5340
service delivery systems AUD 5310, AUD 5332, AUD 5339
• A20. Management and business practices, including but X AUD 5291, AUD 5292, AUD 5293, AUD 5346
not limited to cost analysis, budgeting, coding, billing AUD 5346
and reimbursement, and patient management
• A21. Advocacy for individual patient needs and for X AUD 5238, AUD 5291, AUD 5292, AUD 5345, AUD 5346
legislation beneficial to the profession and the individuals AUD 5293, AUD 5345, AUD 5346,
served AUD 5361
• A22. Legal and ethical practices, including standards X AUD 5238, AUD 5291, AUD 5292, AUD 5310, AUD 5346
for professional conduct, patient rights, confidentiality, AUD 5293, AUD 5310, AUD 5346,
credentialing, and legislative and regulatory mandates AUD 5361
• A23. Principles and practices of effective X AUD 5291, AUD 5292, AUD 5293
supervision/mentoring of students, other professionals,
and support personnel
Standard II-B: Prevention and Screening
• B1. Educating the public and those at risk on X AUD 5310, AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5346, AUD 5347
prevention, potential causes, effects, and treatment of AUD 5580, AUD 5585-Fa2, AUD
congenital and acquired auditory and vestibular disorders 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B2. Establishing relationships with professionals and X AUD 5310, AUD 5325, AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5353
community groups to promote hearing wellness for all AUD 5580, AUD 5585-Fa2, AUD
individuals across the life span 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B3. Participating in programs designed to reduce the X AUD 5325, AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325, AUD 5353
effects of noise exposure and agents that are toxic to the AUD 5580, AUD 5585-Fa2, AUD
auditory and vestibular systems 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B4. Utilizing instrument(s) (i.e. sound-level meter, X AUD 5310, AUD 5318, AUD 5325, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5325,
dosimeter, etc.) to determine ambient noise levels and AUD 5353, AUD 5359 AUD 5580, AUD 5585-Fa2, AUD AUD 5353, AUD 5359
providing strategies for reducing noise and reverberation 5585-Fa3, AUD 5585-Sp1, AUD
time in educational, occupational, and other settings 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B5. Recognizing a concern on the part of medical X AUD 5310, AUD 5325, AUD 5332 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325
providers, individuals, caregivers, or other professionals AUD 5580, AUD 5585-Fa2, AUD
about hearing and/or speech-language problems and/or 5585-Fa3, AUD 5585-Sp1, AUD
identifying people at risk to determine a need for hearing 5585-Sp2, AUD 5585-Sp3, AUD
screening 5585-Su1, AUD 5585-Su2
55
56
• B6. Conducting hearing screenings in accordance with X AUD 5310, AUD 5318, AUD 5325 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5325
established federal and state legislative and regulatory AUD 5580, AUD 5585-Fa2, AUD
requirements 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B7. Participating in occupational hearing conservation X AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
programs AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B8. Performing developmentally, culturally, and X AUD 5310, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310
linguistically appropriate hearing screening procedures AUD 5580, AUD 5585-Fa2, AUD
across the life span 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B9. Referring persons who fail the hearing screening X AUD 5310, AUD 5318, AUD 5325, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5325
for appropriate audiologic/medical evaluation AUD 5337 AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B10. Identifying persons at risk for speech-language X AUD 5325, SLP 5304 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325
and/or cognitive disorders that may interfere with AUD 5580, AUD 5585-Fa2, AUD
communication, health, education, and/or psychosocial 5585-Fa3, AUD 5585-Sp1, AUD
function 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B11. Screening for comprehension and production of X SLP 5304 AUD 5355-Fa4, AUD 5355-Sp4,
language, including the cognitive and social aspects of AUD 5580, AUD 5585-Fa2, AUD
communication 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B12. Screening for speech production skills (e.g., X AUD 5325, SLP 5304 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325
articulation, fluency, resonance, and voice AUD 5580, AUD 5585-Fa2, AUD
characteristics) 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B13. Referring persons who fail the screening for X AUD 5325, SLP 5304 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325
appropriate speech-language pathology consults, medical AUD 5580, AUD 5585-Fa2, AUD
evaluation, and/or services, as appropriate 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• B14. Evaluating the success of screening and X AUD 5238, AUD 5310, AUD 5339, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5340, AUD 5346
prevention programs through the use of performance AUD 5346 AUD 5580, AUD 5585-Fa2, AUD
measures (i.e., test sensitivity, specificity, and positive 5585-Fa3, AUD 5585-Sp1, AUD
predictive value) 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2

Standard II-C: Audiologic Evaluation
• C1. Gathering, reviewing, and evaluating information X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5340,
from referral sources to facilitate assessment, planning, AUD 5339, AUD 5346 AUD 5580, AUD 5585-Fa2, AUD AUD 5346
and identification of potential etiologic factors 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C2. Obtaining a case history and client/patient narrative X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5340,
AUD 5339, AUD 5345, AUD 5346, AUD 5580, AUD 5585-Fa2, AUD AUD 5345, AUD 5346, AUD 5347
AUD 5347, AUD 5361 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C3. Obtaining client/patient-reported and/or caregiver- X AUD 5310, AUD 5325, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5345,
reported measures to assess function AUD 5346, AUD 5347, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5346, AUD 5347
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C4. Identifying, describing, and differentiating among X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5347
disorders of the peripheral and central auditory systems AUD 5337, AUD 5347 AUD 5580, AUD 5585-Fa2, AUD
and the vestibular system 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C5. Providing assessments of tinnitus severity and its X AUD 5353, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
impact on patients’ activities of daily living and quality AUD 5580, AUD 5585-Fa2, AUD
of life 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C6. Providing assessment of tolerance problems to X AUD 5345, AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5345, AUD 5353
determine the presence of hyperacusis AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C7. Selecting, performing, and interpreting a complete X AUD 5310, AUD 5325, AUD 5332 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325
immittance test battery based on patient need and other AUD 5580, AUD 5585-Fa2, AUD
findings; tests to be considered include single probe tone 5585-Fa3, AUD 5585-Sp1, AUD
tympanometry or multifrequency and multicomponent 5585-Sp2, AUD 5585-Sp3, AUD
protocols, ipsilateral and contralateral acoustic reflex 5585-Su1, AUD 5585-Su2
threshold measurements, acoustic reflex decay
measurements, and Eustachian tube function
• C8. Selecting, performing, and interpreting X AUD 5310, AUD 5325, AUD 5332 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325
developmentally appropriate behavioral pure-tone air and AUD 5580, AUD 5585-Fa2, AUD
bone tests, including extended frequency range when 5585-Fa3, AUD 5585-Sp1, AUD
indicated 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
57
58
• C9. Selecting, performing, and interpreting X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5354
developmentally appropriate behavioral speech AUD 5354 AUD 5580, AUD 5585-Fa2, AUD
audiometry procedures to determine speech awareness 5585-Fa3, AUD 5585-Sp1, AUD
threshold (SAT), speech recognition threshold (SRT), and 5585-Sp2, AUD 5585-Sp3, AUD
word recognition scores (WRSs); obtaining a 5585-Su1, AUD 5585-Su2
performance intensity function with standardized speech
materials, when indicated
• C10. Evaluating basic audiologic findings and X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325, AUD 5345,
client/patient needs to determine differential diagnosis AUD 5345, AUD 5354, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5354
and additional procedures to be used 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C11. Selecting, performing, and interpreting X AUD 5325, AUD 5332, AUD 5337, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325, AUD 5346, AUD 5347
physiologic and electrophysiologic test procedures, AUD 5346, AUD 5347 AUD 5580, AUD 5585-Fa2, AUD
including electrocochleography, auditory brainstem 5585-Fa3, AUD 5585-Sp1, AUD
response with frequency-specific air and bone conduction 5585-Sp2, AUD 5585-Sp3, AUD
threshold testing, and click stimuli for neural diagnostic 5585-Su1, AUD 5585-Su2
purposes
• C12. Selecting, performing, and interpreting X AUD 5310, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325
otoacoustic emissions testing AUD 5337 AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C13. Selecting, performing, and interpreting tests for X AUD 5310, AUD 5325 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5325
nonorganic hearing loss AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C14. Selecting, performing, and interpreting vestibular X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
testing, including electronystagmography AUD 5580, AUD 5585-Fa2, AUD
(ENG)/videonystagmography (VNG), ocular vestibular- 5585-Fa3, AUD 5585-Sp1, AUD
evoked myogenic potential (oVEMP), and cervical 5585-Sp2, AUD 5585-Sp3, AUD
vestibular evoked myogenic potential (cVEMP) 5585-Su1, AUD 5585-Su2
• C15. Selecting, performing, and interpreting tests to X AUD 5318 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
evaluate central auditory processing disorder AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C16. Electrophysiologic testing, including but not X AUD 5337 AUD 5355-Fa4, AUD 5355-Sp4,
limited to auditory steady-state response, auditory middle AUD 5580, AUD 5585-Fa2, AUD
latency response, auditory late (long latency) response, 5585-Fa3, AUD 5585-Sp1, AUD
and cognitive potentials (e.g., P300 response, mismatch 5585-Sp2, AUD 5585-Sp3, AUD
negativity response) 5585-Su1, AUD 5585-Su2

• C17. Posturography X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C18. Rotary chair tests X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• C19. Video head impulse testing (vHIT) X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
Standard II-D: Counseling
• D1. Identifying the counseling needs of individuals X AUD 5310, AUD 5318, AUD 5325, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5325,
with hearing impairment based on their narratives and AUD 5332, AUD 5339, AUD 5345, AUD 5580, AUD 5585-Fa2, AUD AUD 5340, AUD 5345, AUD 5346
results of client/patient and/or caregiver responses to AUD 5346, AUD 5361 5585-Fa3, AUD 5585-Sp1, AUD
questionnaires and validation measures 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D2. Providing individual, family, and group counseling X AUD 5318, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5325, AUD 5340,
as needed based on client/patient and clinical population AUD 5339, AUD 5347, AUD 5353, AUD 5580, AUD 5585-Fa2, AUD AUD 5347, AUD 5353
needs AUD 5361 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D3. Facilitating and enhancing clients’/patients’ and X AUD 5318, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5325, AUD 5340,
their families’ understanding of, acceptance of, and AUD 5339, AUD 5346, AUD 5347, AUD 5580, AUD 5585-Fa2, AUD AUD 5346, AUD 5347
adjustment to auditory and vestibular disorders AUD 5361 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D4. Enhancing clients’/patients’ acceptance of and X AUD 5318, AUD 5332, AUD 5339, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5345,
adjustment to hearing aids, hearing assistive AUD 5345, AUD 5353, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5353
technologies, and osseointegrated and other implantable 5585-Fa3, AUD 5585-Sp1, AUD
devices 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D5. Addressing the specific interpersonal, psychosocial, X AUD 5318, AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340
educational, and vocational implications of hearing AUD 5580, AUD 5585-Fa2, AUD
impairment for the client/patient, family members, and/or 5585-Fa3, AUD 5585-Sp1, AUD
caregivers to enhance their well-being and quality of life 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
59
60
• D6. Facilitating patients’ acquisition of effective X AUD 5318, AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340
communication and coping skills AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D7. Promoting clients’/patients’ self-efficacy beliefs X AUD 5318, AUD 5339, AUD 5353, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5353
and promoting self-management of communication and AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
related adjustment problems 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D8. Enhancing adherence to treatment plans and X AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340
optimizing treatment outcomes AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• D9. Monitoring and evaluating client/patient progress X AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340
and modifying counseling goals and approaches, as AUD 5580, AUD 5585-Fa2, AUD
needed 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
Standard II-E: Audiologic Rehabilitation Across the Life
Span
• E1. Engaging clients/patients in the identification of X AUD 5310, AUD 5318, AUD 5339, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5340,
their specific communication and adjustment difficulties AUD 5354, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5354
by eliciting client/patient narratives and interpreting their 5585-Fa3, AUD 5585-Sp1, AUD
and/or caregiver-reported measures 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E2. Identifying the need for, and providing for X AUD 5325, AUD 5339, AUD 5346, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325, AUD 5340, AUD 5346,
assessment of, concomitant cognitive/developmental AUD 5354, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5354
concerns, sensory-perceptual and motor skills, and other 5585-Fa3, AUD 5585-Sp1, AUD
health/medical conditions, as well as participating in 5585-Sp2, AUD 5585-Sp3, AUD
interprofessional collaboration to provide comprehensive 5585-Su1, AUD 5585-Su2
management and monitoring of all relevant issues
• E3. Responding empathically to clients’/patients’ and X AUD 5310, AUD 5318, AUD 5325, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5325,
their families’ concerns regarding communication and AUD 5339, AUD 5353, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5340, AUD 5353
adjustment difficulties to establish a trusting therapeutic 5585-Fa3, AUD 5585-Sp1, AUD
relationship 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E4. Providing assessments of family members’ X AUD 5318, AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340
perception of and reactions to communication difficulties AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2

• E5. Identifying the effects of hearing problems and X AUD 5310, AUD 5318, AUD 5339, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5310, AUD 5318, AUD 5340,
subsequent communication difficulties on marital dyads, AUD 5353, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5353
family dynamics, and other interpersonal communication 5585-Fa3, AUD 5585-Sp1, AUD
functioning 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E6. Engaging clients/patients (including, as appropriate, X AUD 5238, AUD 5318, AUD 5339, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340
school-aged children/adolescents) and family members in AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
shared decision making regarding treatment goals and 5585-Fa3, AUD 5585-Sp1, AUD
options 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E7. Developing and implementing individualized X AUD 5238, AUD 5318, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5345, AUD 5346,
intervention plans based on clients’/patients’ preferences, AUD 5346, AUD 5353, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5353
abilities, communication needs and problems, and related 5585-Fa3, AUD 5585-Sp1, AUD
adjustment difficulties 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E8. Selecting and fitting appropriate amplification X AUD 5318, AUD 5339, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5345,
devices and assistive technologies AUD 5353, AUD 5354 AUD 5580, AUD 5585-Fa2, AUD AUD 5353, AUD 5354
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E9. Defining appropriate electroacoustic characteristics X AUD 5339, AUD 5345 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340, AUD 5345
of amplification fittings based on frequency-gain AUD 5580, AUD 5585-Fa2, AUD
characteristics, maximum output sound-pressure level, 5585-Fa3, AUD 5585-Sp1, AUD
and input–output characteristics 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E10. Verifying that amplification devices meet quality X AUD 5339, AUD 5345 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340, AUD 5345
control and American National Standards Institute AUD 5580, AUD 5585-Fa2, AUD
(ANSI) standards 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E11. Conducting real-ear measurements to (a) establish X AUD 5325, AUD 5339, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5325, AUD 5340, AUD 5345,
audibility, comfort, and tolerance of speech and sounds in AUD 5353 AUD 5580, AUD 5585-Fa2, AUD AUD 5353
the environment and (b) verify compression, 5585-Fa3, AUD 5585-Sp1, AUD
directionality, and automatic noise management 5585-Sp2, AUD 5585-Sp3, AUD
performance 5585-Su1, AUD 5585-Su2
• E12. Incorporating sound field functional gain testing X AUD 5339, AUD 5353, AUD 5354 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340, AUD 5353, AUD 5354
when fitting osseointegrated and other implantable AUD 5580, AUD 5585-Fa2, AUD
devices 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E13. Conducting individual and/or group hearing aid X AUD 5318, AUD 5339, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5345
orientations to ensure that clients/patients can use, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
manage, and maintain their instruments appropriately 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
61
62
• E14. Identifying individuals who are candidates for X AUD 5318, AUD 5354, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
cochlear implantation and other implantable devices AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E15. Counseling cochlear implant candidates and their X AUD 5318, AUD 5354, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
families regarding the benefits and limitations of cochlear AUD 5580, AUD 5585-Fa2, AUD
implants to (a) identify and resolve concerns and 5585-Fa3, AUD 5585-Sp1, AUD
potential misconceptions and (b) facilitate decision 5585-Sp2, AUD 5585-Sp3, AUD
making regarding treatment options 5585-Su1, AUD 5585-Su2
• E16. Providing programming and fitting adjustments; X AUD 5318, AUD 5354 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
providing postfitting counseling for cochlear implant AUD 5580, AUD 5585-Fa2, AUD
clients/patients 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E17. Identifying the need for—and X AUD 5318, AUD 5345, AUD 5353, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5345, AUD 5353,
fitting—electroacoustically appropriate hearing assistive AUD 5354, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD AUD 5354
technology systems (HATS) based on clients’/patients’ 5585-Fa3, AUD 5585-Sp1, AUD
communication, educational, vocational, and social needs 5585-Sp2, AUD 5585-Sp3, AUD
when conventional amplification is not indicated or 5585-Su1, AUD 5585-Su2
provides limited benefit
• E18. Providing HATS for those requiring access in X AUD 5318, AUD 5339, AUD 5345 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5345
public and private settings or for those requiring AUD 5580, AUD 5585-Fa2, AUD
necessary accommodation in the work setting, in 5585-Fa3, AUD 5585-Sp1, AUD
accordance with federal and state regulations 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E19. Ensuring compatibility of HATS when used in X AUD 5339, AUD 5345, AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340, AUD 5345, AUD 5353
conjunction with hearing aids, cochlear implants, or other AUD 5580, AUD 5585-Fa2, AUD
devices and in different use environments 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E20. Providing or referring for consulting services in X AUD 5339, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5340
the installation and operation of multi-user systems in a AUD 5580, AUD 5585-Fa2, AUD
variety of environments (e.g., theaters, churches, schools) 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E21. Providing auditory, visual, and auditory–visual X AUD 5318, AUD 5339 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340
communication training (e.g., speechreading, auditory AUD 5580, AUD 5585-Fa2, AUD
training, listening skills) to enhance receptive 5585-Fa3, AUD 5585-Sp1, AUD
communication 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E22. Counseling clients/patients regarding the X AUD 5353, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
audiologic significance of tinnitus and factors that cause AUD 5580, AUD 5585-Fa2, AUD
or exacerbate tinnitus to resolve misconceptions and 5585-Fa3, AUD 5585-Sp1, AUD
alleviate anxiety related to this auditory disorder 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2

• E23. Counseling clients/patients to promote the X AUD 5353, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
effective use of ear-level sound generators and/or the AUD 5580, AUD 5585-Fa2, AUD
identification and use of situationally appropriate 5585-Fa3, AUD 5585-Sp1, AUD
environmental sounds to minimize their perception of 5585-Sp2, AUD 5585-Sp3, AUD
tinnitus in pertinent situations 5585-Su1, AUD 5585-Su2
• E24. Counseling clients/patients to facilitate X AUD 5353, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
identification and adoption of effective coping strategies AUD 5580, AUD 5585-Fa2, AUD
to reduce tinnitus-induced stress, concentration 5585-Fa3, AUD 5585-Sp1, AUD
difficulties, and sleep disturbances 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E25. Monitoring and assessing the use of ear-level X AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5353
and/or environmental sound generators and the use of AUD 5580, AUD 5585-Fa2, AUD
adaptive coping strategies to ensure treatment benefit and 5585-Fa3, AUD 5585-Sp1, AUD
successful outcome(s) 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E26. Providing canalith repositioning for patients X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
diagnosed with benign paroxysmal positional vertigo AUD 5580, AUD 5585-Fa2, AUD
(BPPV) 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E27. Providing intervention for central and peripheral X AUD 5346, AUD 5347 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5346, AUD 5347
vestibular deficits AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• E28. Ensuring treatment benefit and satisfaction by X AUD 5238, AUD 5347, AUD 5353 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5347, AUD 5353
monitoring progress and assessing treatment outcome AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
Standard II-F: Pediatric Audiologic (Re)habilitation
• F1. Counseling parents to facilitate their acceptance of X AUD 5318, AUD 5325, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5325
and adjustment to a child's diagnosis of hearing AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
impairment 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F2. Counseling parents to resolve their concerns and X AUD 5238, AUD 5318, AUD 5332, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
facilitate their decision making regarding early AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
intervention, amplification, education, and related 5585-Fa3, AUD 5585-Sp1, AUD
intervention options for children with hearing impairment 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
63
64
• F3. Educating parents regarding the potential effects of X AUD 5318, AUD 5361, SLP 5304 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
hearing impairment on speech-language, cognitive, and AUD 5580, AUD 5585-Fa2, AUD
social–emotional development and functioning 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F4. Educating parents regarding optional and optimal X AUD 5318, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
modes of communication; educational laws and rights, AUD 5580, AUD 5585-Fa2, AUD
including 504s, individualized education programs 5585-Fa3, AUD 5585-Sp1, AUD
(IEPs), individual family service plans (IFSPs), 5585-Sp2, AUD 5585-Sp3, AUD
individual health plans; and so forth 5585-Su1, AUD 5585-Su2
• F5. Selecting age/developmentally appropriate X AUD 5318, AUD 5339, AUD 5345, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5340, AUD 5345,
amplification devices and HATS to minimize auditory AUD 5353 AUD 5580, AUD 5585-Fa2, AUD AUD 5353
deprivation and maximize auditory stimulation 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F6. Instructing parents and/or child(ren) regarding the X AUD 5318, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
daily use, care, and maintenance of amplification devices AUD 5580, AUD 5585-Fa2, AUD
and HATS 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F7. Planning and implementing parent X AUD 5318, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
education/support programs concerning the management AUD 5580, AUD 5585-Fa2, AUD
of hearing impairment and subsequent communication 5585-Fa3, AUD 5585-Sp1, AUD
and adjustment difficulties 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F8. Providing for intervention to ensure X AUD 5318, AUD 5354 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
age/developmentally appropriate speech and language AUD 5580, AUD 5585-Fa2, AUD
development 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F9. Administering self-assessment, parental, and X AUD 5238, AUD 5318, AUD 5354, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
educational assessments to monitor treatment benefit and AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
outcome 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F10. Providing ongoing support for children by X AUD 5318, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
participating in IEP or IFSP processes AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F11. Counseling the child with hearing impairment X AUD 5318, AUD 5361 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318
regarding peer pressure, stigma, and other issues related AUD 5580, AUD 5585-Fa2, AUD
to psychosocial adjustment, behavioral coping strategies, 5585-Fa3, AUD 5585-Sp1, AUD
and self-advocacy skills 5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2

• F12. Evaluating acoustics of classroom settings and X AUD 5318, AUD 5359 AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5359
providing recommendations for modifications AUD 5580, AUD 5585-Fa2, AUD
5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
• F13. Providing interprofessional consultation and/or X AUD 5238, AUD 5318, AUD 5354, AUD 5355-Fa4, AUD 5355-Sp4, AUD 5318, AUD 5354
team management with speech-language pathologists, AUD 5361 AUD 5580, AUD 5585-Fa2, AUD
educators, and other related professionals 5585-Fa3, AUD 5585-Sp1, AUD
5585-Sp2, AUD 5585-Sp3, AUD
5585-Su1, AUD 5585-Su2
65
CALIPSO
66
CALIPSO
Knowledge And Skills Acquisition (KASA) Summary Form
Knowledge And Skills Acquisition (KASA) Summary
Doe,Form
Jane
Doe, Jane
2020 CFCC Standards (SLP)
2021 CFCC Standards (AUD)
Standards Knowledge/Skill Course # and Title Practicum Experiences # and Title Other (e.g. labs, research) (include
Met? (check) descriptions of activity)
Standard IV-A. The applicant must have demonstrated
knowledge of:
• Biological Sciences (human or animal sciences) X SLP 5283, SLP 5305, SLP 5316, SLP SLP 5335
5317, SLP 5326, SLP 5331, SLP
5335
• Physical Sciences (physics or chemistry) X SLP 5301, SLP 5316, SLP 5317, SLP SLP 5335
5331, SLP 5335
• Statistics (stand-alone course) X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
5283, SLP 5314, SLP 5335 5314, SLP 5335
• Social/behavioral Sciences (psychology, sociology, X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
anthropology, or public health) 5283, SLP 5305, SLP 5314, SLP 5314, SLP 5335
5316, SLP 5317, SLP 5331, SLP
5335
Standard IV-B. The applicant must demonstrate
knowledge of basic human communication and
swallowing processes, including their biological,
neurological, acoustic, psychological, developmental,
and linguistic and cultural bases. The applicant must have
demonstrated the ability to integrate information
pertaining to normal and abnormal human development
across the life span.
• Basic Human Communication Processes
• Biological X SLP 5235, SLP 5236, SLP 5283, SLP SLP 5335
5301, SLP 5305, SLP 5311, SLP
5316, SLP 5317, SLP 5331, SLP
5335, SLP 5336
• Neurological X SLP 5235, SLP 5236, SLP 5283, SLP SLP 5335
5301, SLP 5305, SLP 5311, SLP
5316, SLP 5317, SLP 5331, SLP
5335, SLP 5336
• Acoustic X SLP 5301, SLP 5311, SLP 5316, SLP
5336
Appendix M

• Psychological X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
5283, SLP 5301, SLP 5311, SLP 5314, SLP 5335
5314, SLP 5316, SLP 5317, SLP
5331, SLP 5335, SLP 5336
• Developmental/Lifespan X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
5301, SLP 5305, SLP 5311, SLP 5314, SLP 5335
5314, SLP 5316, SLP 5317, SLP
5335, SLP 5336
• Linguistic X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
5283, SLP 5301, SLP 5311, SLP 5314, SLP 5335
5314, SLP 5316, SLP 5317, SLP
5331, SLP 5335, SLP 5336
• Cultural X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5280, SLP 5281, SLP 5282, SLP
5283, SLP 5301, SLP 5305, SLP 5314, SLP 5335, SLP 5338
5311, SLP 5314, SLP 5316, SLP
5317, SLP 5331, SLP 5335, SLP
5336, SLP 5338
• Swallowing Processes
• Biological X SLP 5235, SLP 5236, SLP 5319
• Neurological X SLP 5235, SLP 5236, SLP 5319
• Psychological X SLP 5319
• Developmental/Lifespan X SLP 5319
• Cultural X SLP 5319
Standard IV-C. The applicant must have demonstrated
knowledge of communication and swallowing disorders
and differences, including the appropriate etiologies,
characteristics, and anatomical/physiological, acoustic,
psychological, developmental, and linguistic and cultural
correlates in the following areas:
• Speech Sound Production, to encompass articulation,
motor planning and execution, phonology, and accent
modification
• Etiologies X SLP 5301, SLP 5305, SLP 5314, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5316 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Characteristics X SLP 5301, SLP 5305, SLP 5314, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5316 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Fluency and fluency disorders
• Etiologies X SLP 5301, SLP 5305, SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
67
X SLP 5301, SLP 5305, SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
68
• Characteristics
5583-Su1
• Voice and resonance, including respiration and
phonation
• Etiologies X SLP 5301, SLP 5316, SLP 5326, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Characteristics X SLP 5301, SLP 5316, SLP 5326, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Receptive and expressive language to include
phonology, morphology, syntax, semantics, pragmatics
(language use and social aspects of communication),
prelinguistic communication, and paralinguistic
communication (e.g., gestures, signs, body language),
and literacy in speaking, listening, reading, and writing
• Etiologies X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5283, SLP 5305, SLP 5317, SLP SLP 5583-Sp1, SLP 5583-Sp2, SLP 5335
5331, SLP 5335 5583-Su1
• Characteristics X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5331, SLP 5335 5583-Su1
• Hearing, including the impact on speech and language
• Etiologies X SLP 5283, SLP 5301, SLP 5305, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Characteristics X SLP 5283, SLP 5301, SLP 5305, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Swallowing/Feeding, including (a) structure and
function of orofacial myology and (b) oral, pharyngeal,
laryngeal, pulmonary, esophageal, gastrointestinal, and
related functions across the lifespan
• Etiologies X SLP 5319 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Characteristics X SLP 5319 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Cognitive aspects of communication, including
attention, memory, sequencing, problem solving,
executive functioning

• Etiologies X SLP 5283, SLP 5305, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5331, SLP 5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Characteristics X SLP 5283, SLP 5305, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5331, SLP 5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Social aspects of communication, including challenging
behavior, ineffective social skills, and lack of
communication opportunities
• Etiologies X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5317, SLP 5331, SLP 5335 5583-Su1
• Characteristics X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5317, SLP 5331, SLP 5335 5583-Su1
• Augmentative and alternative communication
modalities
• Characteristics X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Standard IV-D: The applicant must have demonstrated
current knowledge of the principles and methods of
prevention, assessment, and intervention for persons with
communication and swallowing disorders, including
consideration of anatomical/physiological, psychological,
developmental, and linguistic and cultural correlates of
the disorders.
modification
• Prevention X SLP 5301, SLP 5314, SLP 5316, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5326 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Assessment X SLP 5301, SLP 5314, SLP 5316, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5326 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Intervention X SLP 5301, SLP 5314, SLP 5316, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5326 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Fluency and Fluency Disorders
• Prevention X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
69
70
• Assessment X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Intervention X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
phonation
• Prevention X SLP 5301, SLP 5316, SLP 5326, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Assessment X SLP 5301, SLP 5316, SLP 5326, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Intervention X SLP 5301, SLP 5316, SLP 5326, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Prevention X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5335 5583-Su1
• Assessment X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5335 5583-Su1
• Intervention X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5335 5583-Su1
• Prevention X SLP 5283, SLP 5314, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5583-Su1
• Assessment X SLP 5283, SLP 5314, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5583-Su1
• Intervention X SLP 5283, SLP 5314, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5314
5583-Su1

• Prevention X SLP 5319 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Assessment X SLP 5319 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Intervention X SLP 5319 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
• Prevention X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Assessment X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Intervention X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
• Prevention X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5331, SLP 5335 5583-Su1
• Assessment X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5331, SLP 5335 5583-Su1
• Intervention X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
5331, SLP 5335 5583-Su1
modalities
• Assessment X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
71
72
• Intervention X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Standard IV-E: The applicant must have demonstrated X SLP 5283, SLP 5335, SLP 5336, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
knowledge of standards of ethical conduct. 5357 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Standard IV-F: The applicant must have demonstrated X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
knowledge of processes used in research and of the 5335, SLP 5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP 5335
integration of research principles into evidence-based 5583-Su1
clinical practice.
Standard IV-G: The applicant must have demonstrated X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282
knowledge of contemporary professional issues. 5283, SLP 5336, SLP 5357 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Standard IV-H: The applicant must have demonstrated X SLP 5283, SLP 5335, SLP 5336, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
knowledge of entry level and advanced certifications, 5357 SLP 5583-Sp1, SLP 5583-Sp2, SLP
licensure, and other relevant professional credentials, as 5583-Su1
well as local, state, and national regulations and policies
relevant to professional practice.
Standard V-A: The applicant must have demonstrated X SLP 5280, SLP 5281, SLP 5282, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5280, SLP 5281, SLP 5282, SLP
skills in oral and written or other forms of 5283, SLP 5335, SLP 5336 SLP 5583-Sp1, SLP 5583-Sp2, SLP 5335
communication sufficient for entry into professional 5583-Su1
practice (including Speech and Language skills in
English, consistent with ASHA’s position statement on
students and professionals who speak English with
accents and nonstandard dialects).
Standard V-B: The applicant must have completed a
program of study that included supervised clinical
experiences sufficient in breadth and depth to achieve the
following skills outcomes. (These skills may be
developed and demonstrated through direct clinical
experiences, academic coursework, labs, simulations, and
examinations, as well as through the completion of
independent projects.)
1. Evaluation (must include all skill outcomes listed in a-
g below for each of the 9 major areas except that
prevention does not apply to communication modalities)
modification
Std. V-B 1a. Conduct screening and prevention X SLP 5316, SLP 5326 SLP 5240, SLP 5355, SLP 5583-Fa2,
procedures, including prevention activities SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1

Std. V-B 1b. Collect case history information and X SLP 5316, SLP 5326, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
integrate information from clients/patients, family, SLP 5583-Sp1, SLP 5583-Sp2, SLP
caregivers, teachers, relevant others, and other 5583-Su1
professionals
Std. V-B 1c. Select and administer appropriate evaluation X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
procedures, such as behavioral observations SLP 5583-Sp1, SLP 5583-Sp2, SLP
nonstandardized and standardized tests, and instrumental 5583-Su1
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5301, SLP 5316, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
needs of individuals receiving services SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
information to develop diagnoses and make appropriate SLP 5583-Sp1, SLP 5583-Sp2, SLP
recommendations for intervention 5583-Su1
Std. V-B 1f. Complete administrative and reporting X SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
functions necessary to support evaluation SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1g. Refer clients/patients for appropriate X SLP 5316, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
services SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1a. Conduct screening and prevention X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1b. Collect case history information and X SLP 5311, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
professionals
Std. V-B 1c. Select and administer appropriate evaluation X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5311, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
73
74
5583-Su1
phonation
5583-Su1
professionals
procedures
5583-Su1
5583-Su1
5583-Su1
5583-Su1
Std. V-B 1b. Collect case history information and X SLP 5317, SLP 5331, SLP 5335, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
integrate information from clients/patients, family, 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
professionals

Std. V-B 1c. Select and administer appropriate evaluation X SLP 5317, SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5317, SLP 5331, SLP 5335, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
needs of individuals receiving services 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5281, SLP 5282, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5281, SLP 5282, SLP 5335
information to develop diagnoses and make appropriate 5331, SLP 5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 1f. Complete administrative and reporting X SLP 5281, SLP 5282, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5281, SLP 5282, SLP 5335
functions necessary to support evaluation 5331, SLP 5335 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1g. Refer clients/patients for appropriate X SLP 5317, SLP 5331, SLP 5335, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
services 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
5583-Su1
professionals
procedures
5583-Su1
5583-Su1
5583-Su1
75
76
5583-Su1
professionals
procedures
5583-Su1
5583-Su1
5583-Su1
5583-Su1
professionals
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5317, SLP 5331, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1

Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5281, SLP 5282, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5281, SLP 5282
information to develop diagnoses and make appropriate 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 1f. Complete administrative and reporting X SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1g. Refer clients/patients for appropriate X SLP 5317, SLP 5331, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1a. Conduct screening and prevention X SLP 5316, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1b. Collect case history information and X SLP 5316, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
integrate information from clients/patients, family, 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
professionals
Std. V-B 1c. Select and administer appropriate evaluation X SLP 5316, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5316, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
needs of individuals receiving services 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5281, SLP 5282, SLP 5316, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5281, SLP 5282
information to develop diagnoses and make appropriate 5317, SLP 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 1f. Complete administrative and reporting X SLP 5316, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 1g. Refer clients/patients for appropriate X SLP 5316, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
services 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
modalities
Std. V-B 1a. Conduct screening procedures X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
77
78
Std. V-B 1b. Collect case history information and X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
professionals
Std. V-B 1c. Select and administer appropriate evaluation X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
procedures
Std. V-B 1d. Adapt evaluation procedures to meet the X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Std. V-B 1e. Interpret, integrate, and synthesize all X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
Std. V-B 1f. Complete administrative and reporting X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Std. V-B 1g. Refer clients/patients for appropriate X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
2. Intervention (must include all skill outcomes listed in
a-g below for each of the 9 major areas)
modification
Std. V-B 2a. Develop setting-appropriate intervention X SLP 5316, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
plans with measurable and achievable goals that meet SLP 5583-Sp1, SLP 5583-Sp2, SLP
clients'/patients' needs. Collaborate with clients/patients 5583-Su1
and relevant others in the planning process
Std. V-B 2b. Implement intervention plans that involve X SLP 5316, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
clients/patients and relevant others in the intervention SLP 5583-Sp1, SLP 5583-Sp2, SLP
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
materials and instrumentation for prevention and SLP 5583-Sp1, SLP 5583-Sp2, SLP
intervention 5583-Su1
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
performance and progress SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 2e. Modify intervention plans, strategies, X SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
materials, or instrumentation as appropriate to meet the SLP 5583-Sp1, SLP 5583-Sp2, SLP
needs of clients/patients 5583-Su1

functions necessary to support intervention SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 2g. Identify and refer clients/patients for X SLP 5316, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
services as appropriate SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5311 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
5583-Su1
5583-Su1
phonation
Std. V-B 2b. Implement intervention plans that involve X SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2,
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
79
80
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5301, SLP 5316 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
5583-Su1
5583-Su1
Std. V-B 2a. Develop setting-appropriate intervention X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
plans with measurable and achievable goals that meet 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 2b. Implement intervention plans that involve X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
clients/patients and relevant others in the intervention 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 2e. Modify intervention plans, strategies, X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 2g. Identify and refer clients/patients for X SLP 5283, SLP 5317, SLP 5331, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
services as appropriate 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1

process. 5583-Su1
5583-Su1
5583-Su1
5583-Su1
process. 5583-Su1
5583-Su1
81
82
5583-Su1
5583-Su1
plans with measurable and achievable goals that meet 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
clients/patients and relevant others in the intervention 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
Std. V-B 2e. Modify intervention plans, strategies, X SLP 5283, SLP 5317, SLP 5331 SLP 5240, SLP 5355, SLP 5583-Fa2,
5583-Su1
services as appropriate 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
plans with measurable and achievable goals that meet 5331, SLP 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
clients/patients and relevant others in the intervention 5331, SLP 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
process. 5583-Su1

Std. V-B 2c. Select or develop and use appropriate X SLP 5283, SLP 5316, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
materials and instrumentation for prevention and 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5283, SLP 5316, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
performance and progress 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
Std. V-B 2e. Modify intervention plans, strategies, X SLP 5283, SLP 5316, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
materials, or instrumentation as appropriate to meet the 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
Std. V-B 2f. Complete administrative and reporting X SLP 5283, SLP 5316, SLP 5317, SLP SLP 5240, SLP 5355, SLP 5583-Fa2,
functions necessary to support intervention 5331 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
services as appropriate 5331, SLP 5361 SLP 5583-Sp1, SLP 5583-Sp2, SLP
5583-Su1
modalities
Std. V-B 2a. Develop setting-appropriate intervention X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
Std. V-B 2b. Implement intervention plans that involve X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
process. 5583-Su1
Std. V-B 2c. Select or develop and use appropriate X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
Std. V-B 2d. Measure and evaluate clients'/patients' X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Std. V-B 2e. Modify intervention plans, strategies, X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
Std. V-B 2f. Complete administrative and reporting X SLP 5331, SLP 5335 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
Std. V-B 2g. Identify and refer clients/patients for X SLP 5331, SLP 5335, SLP 5361 SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
5583-Su1
3. Interaction and Personal Qualities
83
84
Std. V-B 3a. Communicate effectively, recognizing the X SLP 5283, SLP 5305, SLP 5311, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
needs, values, preferred mode of communication, and 5316, SLP 5317, SLP 5326, SLP SLP 5583-Sp1, SLP 5583-Sp2, SLP
cultural/linguistic background of the individual(s) 5331, SLP 5335, SLP 5361 5583-Su1
receiving services, family, caregivers, and relevant others.
Std. V-B 3b. Manage the care of individuals receiving X SLP 5283, SLP 5305, SLP 5316, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
services to ensure an interprofessional, team-based 5317, SLP 5326, SLP 5331, SLP SLP 5583-Sp1, SLP 5583-Sp2, SLP
collaborative practice. 5335, SLP 5357 5583-Su1
Std. V-B 3c. Provide counseling regarding X SLP 5283, SLP 5305, SLP 5311, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
communication and swallowing disorders to 5316, SLP 5317, SLP 5331, SLP SLP 5583-Sp1, SLP 5583-Sp2, SLP
clients/patients, family, caregivers, and relevant others. 5335, SLP 5361 5583-Su1
Std. V-B 3d. Adhere to the ASHA Code of Ethics and X SLP 5283, SLP 5305, SLP 5311, SLP SLP 5240, SLP 5355, SLP 5583-Fa2, SLP 5335
behave professionally. 5316, SLP 5317, SLP 5326, SLP SLP 5583-Sp1, SLP 5583-Sp2, SLP
5331, SLP 5335, SLP 5357, SLP 5583-Su1
5361

Appendix N
2022 REQUEST FOR 4th YEAR Au.D. EXTERNSHIP

STUDENT INFORMATION
Name:
Address:
Phone Number:
Vanderbilt Email:
In general, describe your preferred placement (ex: VU vs. external, state, city, employer, pediatrics/adults, private practice, VA,
school, outpatient, etc.):
PREFERRED PLACEMENT SITES (List up to 6 sites in order of preference.)

#1
Name of facility:
Name of contact (if known):
Address:
Website:
Phone #:
#2
Name of facility:
Address:
Website:
Phone #:
#3
Name of facility:
Address:
Website:
Phone #:
#4
Name of facility:
Address:
Website:
Phone #:
#5
Name of facility:
Address:
Website:
Phone #:
#6
Name of facility:
Address:
Website:
Phone #:
NOTES: Submit this form electronically to Dr. Fino-Szumski before or during your scheduled appointment.
85
Appendix O
2022 REQUEST FOR M.S.-SLP EXTERNSHIP
STUDENT INFORMATION
Name:
Phone Number:
Vanderbilt Email:
Check One:
_____ I came into the program with a background and will complete my externship in the spring semester of 2022
_____ I came into the program without a background and will complete my externship in the summer semester of 2022
In general, describe your preferred placement (ex: VU vs. external, state, city, employer, acute, rehabilitation, school, outpa-
tient, etc.):
PREFERRED EXTERNSHIP SITES (List up to 3 sites in order of preference.)

#1
Name of facility:
Address:
Website:
Phone #:
#2
Name of facility:
Address:
Website:
Phone #:
#3
Name of facility:
Address:
Website:
Phone #:
Submit this form electronically to Dr. Jacobson before or during your scheduled appointment. Scheduled meetings will
begin on 03/11/2022.
86
2022 M.S.-SLP EXTERNSHIP INFORMATION
EXTERNSHIP DATES
Spring Summer
Start: Monday, 02/14/2022 Start: Monday, 06/06/2022
End: Friday, 04/22/2022 End: Friday, 08/12/2022
Duration = 10 weeks (some sites require 12 weeks)

*School placements start earlier to allow for school closings for break.
Early start or late end dates, must be approved by Dr. Fino-Szumski.
PROCESS
1. describe your preferred placement (VU vs. external, city, state, acute, rehabilitation, schools, outpatient, etc.).
2. identify top 3 sites and research them.
3. fill out Request for M.S.-SLP Externship form (Please type information).
4. sign up for a time to meet and discuss your preferred sites with Dr. Jacobson.
5. submit Request for M.S.-SLP Externship form electronically to Dr. Jacobson.
6. meet with Dr. Jacobson.
7. Dr. Jacobson will make contact with sites and notify you if placements are available.
8. for available sites, Dr. Jacobson will advise of next steps (resume, cover letter, interview, application, etc.).
9. if we cannot secure a placement from initial list of preferred sites, Dr. Jacobson will setup another meeting to
strategize next steps.
10. first offer for an externship is the one you are advised to take.
REQUIREMENTS (Dr. Fino-Szumski)

Must have the following in place to finalize/confirm an externship:
1. state authorization (no longer issue)
2. active affiliation agreement with VU.
87
2022 M.S.-SLP EXTERNSHIP INFORMATION
DOCUMENTATION
This is the usual documentation required by our affiliation agreements:
• immunization records (Student Health)
- PPD tuberculin skin test or chest x-ray within one year of clinical experience;
- positive serology of immunity to Rubella and Rubeola or MMR vaccination;
- Hepatitis B vaccinations or waiver indicating refusal;
- positive serology of immunity to varicella or immunization.
- COVID vaccinations
• CPR Training (check expiration date)
• health insurance in effect during the entire externship
• training: OSHA/Blood Borne Pathogens
• training: HIPAA regulations
• background check within 1-year
• fingerprint check – Varies and may be required for another state
• 10-panel drug screen – Varies and may need to be done in a specified timeframe
• VU liability insurance – Provided by VU as specified in the agreement
Other costs that may also be responsibility of student:

• worker’s compensation insurance
• liability insurance
• onboarding fee
• additional background screenings
• drug testing
NOTES:
88
Appendix P
Appendix P
Your Rights and Responsibilities as a Patient

We will treat you without regard to • Be told what you can expect from • Give us a copy of any living will,
your race, nationality, religion, beliefs, your treatment, its risks and power of attorney, or donor forms
age, disability, sex, sexual orientation, benefits, other choices you may you may have.
gender identity or expression, or have, and what might happen if • Follow all hospital and clinic rules,
source of payment. you are not treated at all. including the no smoking policy.
You have the right to considerate and • Have your wishes for advance care • Respect other patients, visitors,
respectful care, including the right to: (living will, power of attorney) or staff, and property.
• Be safe from abuse or harassment. organ donation followed. • Tell us if you are concerned about
• Have your pain treated. • Meet with an ethicist, chaplain, or or notice any changes in your
• Have your doctor and a friend or advocate to talk about ethical issues condition.
member of your family told that and policies. • Make sure your bills are paid.
you are in the hospital. • Refuse tests or treatment (as far as • Go to all of your appointments and
• Be free from being restrained or the law allows) and to be told what be on time.
secluded, unless needed for might happen if you do. • Let us know if you are concerned
your care. • Leave the hospital (as far as the about your privacy.
• Wear appropriate clothing or law allows) even if advised against If you have concerns or complaints:
cultural or religious items as long it. If this happens, we will not be • If you are a patient at Vanderbilt
as doing this doesn’t interfere with responsible for any medical issues Psychiatric Hospital, contact the
your treatment. that may result. Patient Advocate at 615-327-7085.
• Know the names of the people • Be involved in research only if you Otherwise, contact the Office of
caring for you, what they do, and agree to this in writing. Patient Affairs at 615-322-6154.
who they work for. • Be given information about any Any member of our staff can help
• Have an interpreter at no cost if ongoing care you may need after you with this.
you need one. you leave the hospital. You will not • You may also contact the Joint
be sent to another place without Commission at 630-792-5800 or
• Have an assistive (service) animal
being told why. http://www.jointcommission.org.
or aid if you need one.
• Have a support person of your • Or you may contact the Tennessee
• See your bills and have them
choice with you in the hospital or Department of Health:
explained to you.
clinic exam room unless the presence
• Talk with other doctors (at your State of Tennessee
of that person interferes with your
own expense). Department of Health Care Facilities
care or other patients’ care.
• Have your complaints handled West Tennessee Regional Office
fairly. Your care will not be affected To keep you safe, we encourage you 2975 Highway 45 Bypass
if you share any complaints with us. to become actively involved in your Jackson, TN 38305
care by: Phone: 800-778-4504
You have the right to privacy, • Confirming to us which part of Fax: 731-512-0063
including the right to:
your body will be operated on. If you have TennCare and have
• Be examined in as private an area • Reminding us to check your ID problems getting medical care, ask for
as possible. band before we give you medicine a copy of the TennCare medical appeal
• Have someone of your own sex or blood. form. You may also contact:
with you when you are examined. • Making sure we wash or foam our TNCARE Solutions
• Have your medical information hands before caring for you. PO Box 593
kept private, as provided by law. • Checking for our ID badge. Nashville, TN 37202-0593
• Not have any photos or videos • Asking questions. Phone: 800-878-3192
taken of you unless you agree to • Knowing what medicines you are TTY/TDD: 800-772-7647
this, except as needed to treat you. taking and why. Español: 800-254-7568
You have the right to be involved in It is your responsibility to: This information is available in
all aspects of your care. This includes Spanish upon request.
• Give us truthful and complete
the right to:
information about your health, Solicite la versión en español de esta
• Know what your problem is and información.
medicines, and insurance.
what this might mean for you.
• Ask any questions you may have MC-1335 – 08/11
• Share in decisions about your care, about your treatment and what you
including getting information in a need to do to take care of yourself.
way that you can understand. • Follow your plan of treatment.
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Page 1 of 8 Appendix
AppendixQQ
Notice of Privacy Practices

Effective August 1, 2019
This Notice tells how your medical information the patient is and include information about
may be used or shared. It also tells how you can billing and payment.
get your information. Please read it carefully.
• “Use” means sharing or using medical
Ask us if you have any questions. Or call the
information within VUMC.
Privacy Office at (615) 936-3594.
• “Share” means giving medical information,
Why We Keep Information about You or access to information, to someone outside
VUMC.
We keep medical information about you to help
care for you and because the law requires us to.
How We May Use and Share Information
The law also says we must: about You
• protect your medical information We use electronic record systems to manage
your care. These systems have safeguards
• give you this Notice
to protect the information in them. We also
• follow what the Notice says. have policies and training that limit the use of
information to those who need it to do their job.
What the Words We Use Mean
Doctors and other people who are not employed
• “Notice” means this Notice of Privacy by VUMC may share information they have
Practices. about you with our employees in order to care
for you.
• “VUMC” means Vanderbilt University
Medical Center, its staff, and any affiliated Hospitals, clinics, doctors, and other caregivers,
organizations covered by the Notice. (Covered programs, and services may share medical
entities are listed at the end of the Notice.) information about you without your consent for
• “We,” “our,” or “us” means one or more many reasons. Here are just a few examples:
VUMC organizations, providers, or staff.
For Health Information Exchanges (HIEs)
• “You” means the patient that the medical
information is about. We will send your health information to any of
the Health Information Exchanges (HIEs) that
• “Medical information” means all the paper
Vanderbilt participates in. A Health Information
and electronic records related to a patient’s
Exchange (HIE) is a secure electronic system that
physical and mental health care—past,
helps health care providers and entities such as
present, or future. These records tell who
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health plans and insurers manage care and treat We may use and share your information so
patients. We will send your health information that we and others who have provided services
to the Epic Care Everywhere HIE and other to you can bill and collect payment for these
HIEs we choose to participate in. Information services. For example, we may share your
about your past medical care and current medical information with your health plan:
medical conditions and medicines is available
• so your health plan will pay for care you got
not only to us but also to non-VUMC health care
at VUMC
providers who participate in the HIE. You have
the right to opt out of the HIE. However, even • to get approval before doing a procedure
if you do, some of your health information will • so your health plan can make sure they have
remain available to certain health care entities as paid the right amount to VUMC.
permitted by law.
We may also share your information with a
If you have questions or would like to opt out collection agency if a bill is overdue.
of any of the HIEs, contact the Privacy Office
at (615) 936-3594.
For Business Reasons
For Treatment We may use and share information about you

for business reasons. When we do this, we may,
We may use and share medical information to if we can, take out information that identifies
treat you. For example, a doctor treating you who you are.
for a broken leg will need to know if you have
diabetes because diabetes can slow healing. Some of the business reasons we may use or
The doctor may need to tell food services that share your medical information include:
you have diabetes so the right meals can be • to follow laws and regulations
prepared for you.
• to train and educate
We may also share medical information about
• for credentialing, licensure, certification, and
you so that you can get
accreditation
• medicine, medical equipment, or other things
• to improve our care and services
you need for your health care
• to budget and plan
• lab tests, x-rays, transportation, home care,
nursing care, rehab, or other health • to do an audit
care services.
• to maintain computer systems
Medical information may also be shared
• to evaluate our staff
when needed to plan for your care after
you leave VUMC. • to decide if we should offer more services
• to find out how satisfied our patients are

For Billing and Payment
• to bill and collect payment.
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For Organized Health Care Arrangements For Fundraising
We may also allow access to your information to We may use your name, address, phone number,
those health care providers and their authorized the dates and places you got services at VUMC,
representatives that are members of an and the names of your doctors to contact you
organized health care arrangement with VUMC. to try to raise money for VUMC. You have the
The members of such an arrangement are right to ask not to be contacted for fundraising.
operationally or clinically integrated and may If we contact you, we will tell you how to
participate jointly in utilization review, quality prevent future contact if you wish.
assessment and improvement, or payment
activities. Anyone we share information with For the Hospital Directory
in order to do these tasks on behalf of or in
partnership with us must also protect and If you are admitted to the hospital, your name,
restrict the use of your medical information. where you are in the hospital, your general
condition (such as “fair” or “stable”), and your
religion is included in the patient directory at
To Contact You about Appointments, Insurance,
the information desk. This helps family, friends,
and Other Matters
and clergy visit you and learn your condition.
We may contact you by mail, phone, text, or Except for your religion, this information may
email for many reasons, including to: be shared with visitors or phone callers who
ask for you by name. Unless you tell us not to,
• remind you about an appointment
your religion may be shared with a member of
• register you for a procedure the clergy, such as a priest or rabbi, even if you
aren’t asked for by name.
• give you test results
• ask about insurance, billing, or payment If you ask us to take your name from the
directory, we will not share your information
• follow up on your care even if you are asked for by name.
• ask you how well we cared for you.
To Inform Family Members and Friends Involved
We may leave voice messages at the telephone
in Your Care or Paying for Your Care
number you give to us. If you choose to have us
contact you by text, texting charges may apply. We may share information about you with
family members and friends who are involved
To Tell You about Treatment Options or in your care or paying for your care. Whenever
Health-related Products and Services possible, we will allow you to tell us who
you would like to be involved in your care.
We may use or share your information to let you However, in emergencies or other situations in
know about treatment options or health-related which you are unable to tell us who to share
products or services that may interest you. information with, we will use our best judgment
and share only information that others need to
know. We may also share information about you
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with a public or private agency during a disaster need the organs, eyes, and tissues with others
so that the agency can help contact your family involved in getting, storing, and transplanting
or friends to tell them where you are and how the organs, eyes, and tissues.
you are doing.
With Military Authorities
For Research
If you are a member or veteran of the armed
We may use and share medical information forces, we may share your medical information
about you for the research we do to improve with the military as authorized or required
public health and develop new knowledge. by law. We may also share information about
For example, a research project may compare foreign military personnel to the proper foreign
the health and recovery of patients who military authority.
received one medicine for an illness to those
who received a different medicine for the same For Workers’ Compensation
illness. We use and share your information for
research only as allowed by federal and state We may share medical information about you
rules. Each research project is approved through with those who need it in order to provide
a special process that balances the research benefits for work-related injuries or illness.
needs with the patient’s need for privacy. In
most cases, if the research involves your care For Health Oversight and Public Health Reporting
or the sharing of medical information that can
We may share information for audits,
identify you, we will first explain to you how
investigations, inspections, and licensing with
your information will be used and ask your
agencies that oversee health organizations.
consent to use the information. We may access
your medical information before the approval We may also share your medical information in
process to design the research project and reports to public health agencies.
provide the information needed for approval.
Some reasons for this include:
Health information used to prepare a research
project does not leave VUMC. • to prevent or control disease and injuries
• to report certain kinds of events, such as

To Stop a Serious Threat births and deaths
We may share your medical information to • to report abuse or neglect of children, elders,
prevent a serious and urgent threat to the health or dependent adults
and safety of you or someone else. For example,
• to report reactions to medicines or problems
a threat to harm another person may be reported
with medical products
to the police.
• to tell people about recalls of medical
For Organ, Eye, and Tissue Donation products they may be using
We share medical information about organ, eye, • to let someone know that they may have been
and tissue donors and about the patients who exposed to a disease or may spread a disease
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• to notify the authorities if we believe a patient • federal officials who provide protective
has been the victim of abuse, neglect, or services for the President and others, such as
domestic violence. foreign heads of state, or to conduct special
investigations
For Lawsuits and Disputes • a correctional institution if you are an inmate
We may share your medical information as • a school to confirm that you have been
directed by a court order, subpoena, discovery immunized.
request, warrant, summons, or other lawful
instructions from a court or public body when
Other Uses of Your Medical Information
needed for a legal or administrative proceeding.
We will not use or share your medical
With Law Enforcement and Other Officials information for reasons other than those
described in this Notice unless you agree to this
We may share your medical information with in writing. For example, you may want us to
a law enforcement official as authorized or give medical information to your employer. We
required by law: will do this only with your written approval.
• in response to a court order, subpoena, Likewise, we would not use your information
warrant, summons, or similar process for marketing, sell your information, or share
psychotherapy notes without your written
• to identify or find a suspect, fugitive, material approval. You may revoke the approval in
witness, or missing person writing at any time, but we cannot take back
• if you are suspected to be a victim of a crime. any medical information that has already been
(We generally do this with your permission) shared with your approval.
• because of a death we believe may have been

caused by a crime
Your Rights Regarding
Your Medical Information
• because of criminal conduct at the hospital
The records we create and maintain using your
• in an emergency: to report a crime; the medical information belong to VUMC, but you
location of the crime or victims; or the have the following rights:
identity, description, or location of the person
who committed the crime
Right to Review and Get a Copy of
• if you are under the custody of the police or Your Medical Information
other law enforcement official.
You have the right to look at and get a copy of
your medical information, including billing
We May Also Share Your Medical Information with:
records. You must make your request in writing
• coroners, medical examiners, and funeral to Health Information Management at the
directors, so they can carry out their duties address listed at the end of this Notice. We may
charge a fee to cover copying, mailing, and other
• federal officials for national security and
costs and supplies. In rare cases, we may deny
intelligence activities
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your request for certain information. If we deny • with you or someone representing you
your request, we will give you the reason why
• with those who ask for your information as
in writing. In some cases, you may ask that the
listed in the hospital directory
denial be reviewed by a licensed health care
professional chosen by VUMC. • with family members or friends involved in
your care
Right to Ask for a Change in • in those very few instances where the law
Your Medical Information does not require or permit it
If you think our information about you is not • as part of a limited data set with direct
correct or complete, you may ask us to correct identifiers removed
your record by writing to Health Information
• released before April 14, 2003.
Management at the address listed at the end
of this Notice. Your written request must say You must request this list in writing from the
why you are asking for the correction. We will Privacy Office at the address listed at the end
respond in 60 days. of this Notice. Your request must state the time
period for which you want the list. The time
If we agree, we will tell you and correct your
period may not be longer than 6 years from the
record. We cannot take anything out of the
date of your request. The first list you ask for
record. We can only add new information to
within a 12-month period will be free. You may
complete or correct the existing information.
be charged a fee if you ask for another list in that
With your help, we will notify others who have
same 12-month period.
the incorrect or incomplete medical information.
If we deny your request, we will tell you why in Right to Notice in Case of a Breach
writing. You will then have the right to submit a
You have a right to know if your information
written statement of 250 words or less that tells
has been breached (not treated according to our
what you believe is not correct or is missing. We
rules). We will follow what the privacy laws
will add your written statement to your records
require to let you know if your information has
and include it whenever we share the part of
been shared in error.
your medical record that your written statement
relates to.
Right to Ask for Limits on the Use and Sharing of
Right to Ask For a List of When Your Medical Your Medical Information
Information Was Shared You have the right to ask that we limit the use or
sharing of information about you for treatment,
You have the right to ask for a list of when your
payment, or business reasons. You also have the
medical information was shared without your
right to ask us to limit the medical information
written consent.
we share about you with someone involved
This list will NOT include uses or sharing: in your care or paying for your care, such as
a family member or friend. For example, you
• for treatment, payment, or business reasons
could ask that we not share information about
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a surgery you had. Except for the sharing of beyond an episode of care, you will have to pay
information with health plans described in in full for each future visit as well.
the next section, we reserve the right to accept
or reject your request. Generally, we will not Right to Ask for Confidential Communications
accept limits for treatment, payment, or business
reasons. We will let you know if we do not agree You have the right to ask us to communicate
to your request. If we do agree, our agreement with you in a certain way or at a certain place.
must be in writing, and we will follow your For example, you can ask that we contact you
request unless the information is needed to only at work or only using a post office box.
treat you in an emergency. We are allowed to You must make your request in writing to the
end a limit if we tell you. If we end a limit, only Privacy Office at the address listed at the end of
medical information that was created or received this Notice. You do not need to tell us the reason
after we notify you will be affected. for your request. Your request must say how
or where you wish to be contacted. You must
You must make your request to limit the use and also tell us what address to send your bills for
sharing of your medical information in writing to payment. We will accept all reasonable requests.
the Privacy Office at the address listed at the end However, if we are unable to contact you using
of this Notice. In your request, you must tell us the ways or locations you have requested, we
• what information you want to limit may contact you using any information we have.
• whether you want to limit our use or sharing

Right to Get a Paper Copy of This Notice
of the information, or both
You have the right to get a paper copy of this
• AND to whom you want the limits to apply.
Notice, even if you have agreed to receive it
electronically. You may get a copy:
Right to Limit Sharing of Information
with Health Plans • at any of our facilities
If you paid in full for your services, you have the • by contacting the Privacy Office at the
right to limit the information that is shared with number listed at the end of this Notice
your health plan or insurer. To do this, you must • at VanderbiltHealth.com.
ask before you receive any services. Let us know
you want to limit sharing with your health plan Changes to this Notice
when you schedule your appointment.
We have the right to change this Notice at
Any information shared before we receive any time. Any change could apply to medical
payment in full, such as information for pre- information we already have about you, as
authorizing your insurance, may be shared. well as information we receive in the future.
Also, because we have a medical record The effective date of this Notice is on the
system that combines all your records, we can first page of the Notice. A copy of the current
limit information only for an episode of care Notice is posted throughout VUMC and at
(services given during a single visit to the clinic VanderbiltHealth.com.
or hospital). If you wish to limit information
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How to Ask a Question or Report a Complaint Vanderbilt Health Services Affiliated Covered Entities
• Cool Springs Imaging (Williamson Imaging)
If you have questions about this Notice or want
to talk about a problem without filing a formal • Gateway-Vanderbilt Cancer Treatment Center
complaint, please contact the Privacy Office at (615) • One Hundred Oaks Imaging
936-3594. If you believe your privacy rights have • Retail Health Clinics
been violated, you may file a complaint with us.
• Spring Hill Imaging Center
Please send it to the VUMC Privacy Official at the
address listed at the end of this Notice. You may • Vanderbilt Health and Williamson Medical Center
Clinics and Services
also file a complaint with VUMC Patient Relations
or the Office of Civil Rights at the addresses • Vanderbilt Health Pharmacy Group
listed at the end of this Notice. You will not be • Vanderbilt Home Care Services
treated differently for filing a complaint. • Vanderbilt Imaging Services (VIS)
• Vanderbilt Integrated Providers (VIP)

VUMC Operations and Affiliates That Will
• Vanderbilt-Maury Radiation Oncology
Follow the Rules of this Notice:
• VIP MidSouth
• Vanderbilt University Hospital
• Vanderbilt Psychiatric Hospital

Organized Health Care Arrangements
• Vanderbilt Wilson County Hospital (VWCH)
• Vanderbilt Health Affiliated Network (VHAN)
• Monroe Carell Jr. Children’s Hospital at Vanderbilt
• VUMC Medical Staff
• Vanderbilt Medical Group
• VWCH Medical Staff
• VUMC clinics and practices (a detailed list
is available on request) This list may be updated from time to time. For
a current list, contact the VUMC Privacy Office.
• VUMC Outpatient Pharmacies
• Members of the VUMC medical staff

while practicing at VUMC How to Contact Us
• Members of the VWCH medical staff VUMC Privacy Office
while practicing at VWCH 4560 Trousdale Drive, Suite 101, Nashville, TN
37204-4538; (615) 936-3594; [email protected]
• Members of the Vanderbilt School of Medicine when
covered functions involve the use or disclosure of VUMC Health Information Management
protected health information 4560 Trousdale Drive, Suite 101, Nashville, TN
• Members of the Vanderbilt School of Nursing when 37204-4538; (615) 322-2062
covered functions involve the use or disclosure of
VUMC Patient Relations
protected health information
1817 The Vanderbilt Clinic, Nashville, TN 37232-
• VUMC Administration when covered functions 5612; (615) 322-6154
involve the use or disclosure of protected health
information Vanderbilt Wilson County Hospital
Medical Information Services, 1411 Baddour
• Other designated health care components of VUMC Parkway, Lebanon, TN 37087; (615) 444-8262
Office for Civil Rights, Region IV, DHHS

Atlanta Federal Center, 61 Forsyth Street SW,
www.VanderbiltHealth.com 615.322.5000
Suite 3B70, Atlanta, GA 30323
For information only. Not to replace the advice of your health care provider.
Copyright © 2012 Vanderbilt University Medical Center. All rights reserved.
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Appendix R
PRINT-FRIENDLY VERSION
HIPAA BASICS FOR PROVIDERS: PRIVACY, SECURITY,

AND BREACH NOTIFICATION RULES
Target Audience: Medicare Fee-For-Service Providers

The Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink.
The Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Breach
Notification Rules protect the privacy and security of health information and provide individuals with
certain rights to their health information. You play a vital role in protecting the privacy and security of
patient information. This fact sheet discusses:
● The Privacy Rule, which sets national standards for when protected health information (PHI) may
be used and disclosed
● The Security Rule, which specifies safeguards that covered entities and their business associates
must implement to protect the confidentiality, integrity, and availability of electronic protected
health information (ePHI)
● The Breach Notification Rule, which requires covered entities to notify affected individuals; U.S.
Department of Health & Human Services (HHS); and, in some cases, the media of a breach of
unsecured PHI
Page 1 of 8 ICN 909001 September 2018
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HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules MLN Fact Sheet
HIPAA PRIVACY RULE

The HIPAA Privacy Rule establishes standards to protect PHI held by these entities and their
business associates:
● Health plans
● Health care clearinghouses
● Health care providers that conduct certain health care transactions electronically
When “you” is used in this fact sheet, we are referring to these entities and persons.
The Privacy Rule gives individuals important rights with respect to their protected PHI, including rights
to examine and obtain a copy of their health records in the form and manner they request, and to ask
for corrections to their information. Also, the Privacy Rule permits the use and disclosure of health
information needed for patient care and other important purposes.
PHI
The Privacy Rule protects PHI held or transmitted by a covered entity or its business associate, in any
form, whether electronic, paper, or verbal. PHI includes information that relates to all of the following:
● The individual’s past, present, or future physical or mental health or condition
● The provision of health care to the individual
● The past, present, or future payment for the provision of health care to the individual
PHI includes many common identifiers, such as name, address, birth date, and Social Security number.
Visit the HHS HIPAA Guidance webpage for guidance on:
● De-identifying PHI to meet HIPAA Privacy Rule requirements
● Individuals’ right to access health information
● Permitted uses and disclosures of PHI
HIPAA SECURITY RULE

The HIPAA Security Rule specifies safeguards that covered entities and their business associates
must implement to protect ePHI confidentiality, integrity, and availability.
Covered entities and business associates must develop and implement reasonable and appropriate
security measures through policies and procedures to protect the security of ePHI they create,
receive, maintain, or transmit. Each entity must analyze the risks to ePHI in its environment and
create solutions appropriate for its own situation. What is reasonable and appropriate depends on
99
the nature of the entity’s business as well as its size, complexity, and resources. Specifically, covered
entities must:
● Ensure the confidentiality, integrity, and availability of
all ePHI they create, receive, maintain, or transmit Confidentiality: ePHI is not available
● Identify and protect against reasonably anticipated or disclosed to unauthorized persons
threats to the security or integrity of the ePHI or processes
● Protect against reasonably anticipated, impermissible Integrity: ePHI is not altered or
uses or disclosures destroyed in an unauthorized manner
● Ensure compliance by their workforce
Availability: ePHI is accessible and
When developing and implementing Security Rule usable on demand by authorized
compliant safeguards, covered entities and their persons
business associates may consider all of
the following:
● Size, complexity, and capabilities
● Technical, hardware, and software infrastructure
● The costs of security measures
● The likelihood and possible impact of risks to ePHI
Covered entities must review and modify security measures to continue protecting ePHI in a
changing environment.
Visit the HHS HIPAA Guidance webpage for guidance on:
● Administrative, physical, and technical safeguards
● Cybersecurity
● Remote and mobile use of ePHI
HIPAA BREACH NOTIFICATION RULE

The HIPAA Breach Notification Rule requires covered entities to notify affected individuals; HHS;
and, in some cases, the media of a breach of unsecured PHI. Generally, a breach is an impermissible
use or disclosure under the Privacy Rule that compromises the security or privacy of PHI.
The impermissible use or disclosure of PHI is presumed to be a breach unless you demonstrate
there is a low probability the PHI has been compromised based on a risk assessment of at least the
following factors:
● The nature and extent of the PHI involved, including the types of identifiers and the likelihood of
re-identification
● The unauthorized person who used the PHI or to whom the disclosure was made
100
● Whether the PHI was actually acquired or viewed

● The extent to which the risk to the PHI has been mitigated.
Most notifications must be provided without unreasonable delay and no later than 60 days following
the breach discovery. Notifications of smaller breaches affecting fewer than 500 individuals may
be submitted to HHS annually. The Breach Notification Rule also requires business associates of
covered entities to notify the covered entity of breaches at or by the business associate.
Visit the HHS HIPAA Breach Notification Rule webpage for guidance on:
● Administrative requirements and burden of proof
● How to make unsecured PHI unusable, unreadable, or indecipherable to unauthorized individuals
● Reporting requirements
WHO MUST COMPLY WITH HIPAA RULES?

Covered entities and business associates, as applicable, must follow HIPAA rules. If an entity does
not meet the definition of a covered entity or business associate, it does not have to comply with the
HIPAA rules. For the definitions of “covered entity” and “business associate,” see the Code of Federal
Regulations (CFR) Title 45, Section 160.103.
Covered Entities
The following covered entities must follow HIPAA standards and requirements:
● Covered Health Care Provider: Any provider of medical or other health care services or supplies
who transmits any health information in electronic form in connection with a transaction for which
HHS has adopted a standard, such as:
Chiropractors Nursing homes
Clinics Pharmacies
Dentists Psychologists
Doctors
● Health Plan: Any individual or group plan that provides or pays the cost of health care, such as:
Company health plans Health insurance companies
Government programs that pay Health maintenance organizations (HMOs)
for health care, such as Medicare,
Medicaid, and the military and veterans’
health care programs
101
● Health Care Clearinghouse: A public or private entity that processes another entity’s health care
transactions from a standard format to a non-standard format, or vice versa, such as:
Billing services Repricing companies
Community health management Value-added networks
information systems
Business Associates
A business associate is a person or organization, other than a workforce member of a covered entity,
that performs certain functions on behalf of, or provides certain services to, a covered entity that
involve access to PHI. A business associate can also be a subcontractor responsible for creating,
receiving, maintaining, or transmitting PHI on behalf of another business associate. Business
associates provide services to covered entities that include:
● Accreditation ● Financial services
● Billing ● Legal services
● Claims processing ● Management administration
● Consulting ● Utilization review
● Data analysis
NOTE: A covered entity can be a business associate of another covered entity.

If a covered entity enlists the help of a business associate, then a written contract or other
arrangement between the two must:
● Detail the uses and disclosures of PHI the business associate may make
● Require the business associate safeguard the PHI
Visit the HHS HIPAA Covered Entities and Business Associates webpage for more information.
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Enforcement
The HHS Office for Civil Rights enforces the HIPAA Privacy, Security, and Breach Notification Rules.
Violations may result in civil monetary penalties. In some cases, criminal penalties enforced by the
U.S. Department of Justice may apply.
Common violations include:
● Impermissible PHI use and disclosure ● Lack of administrative, technical, or physical
● Use or disclosure of more than the minimum ePHI safeguards
necessary PHI ● Lack of individuals’ access to their PHI
● Lack of PHI safeguards
The following are actual case examples:

● HIPAA Privacy and Security Rule: A wireless health service provider (remote mobile monitoring)
agreed to pay $2.5 million and implement a corrective action plan to settle potential violations of
the HIPAA Privacy and Security Rules. A laptop with 1,391 individuals’ ePHI was stolen from an
employee’s vehicle. The investigation revealed insufficient risk analysis and risk management
processes in place at the time of the theft. Additionally, the organization’s policies and procedures
implementing HIPAA Security Rule standards were in draft form and had not been implemented.
Further, the organization was unable to produce any final policies or procedures regarding the
implementation of safeguards for ePHI, including those for mobile devices.
● HIPAA Breach Notification Rule: A specialty clinic agreed to pay $150,000 to settle potential
violations of the HIPAA rules. An unencrypted thumb drive with the ePHI of about 2,200
individuals was stolen from a clinic employee’s vehicle. The investigation revealed the clinic had
not accurately or thoroughly analyzed the potential risks and vulnerabilities to the confidentiality
of ePHI as part of its security management process. Further, the clinic did not fully comply with
requirements of the Breach Notification Rule to have written policies and procedures in place and
train workforce members. This case was the first settlement with a covered entity for not having
policies and procedures to address the HIPAA Breach Notification Rule.
● Criminal prosecution: A former hospital employee pleaded guilty to criminal HIPAA charges
after obtaining PHI with the intent to use it for personal gain. He was sentenced to 18 months in
Federal prison.
Visit the HHS HIPAA Compliance and Enforcement webpage for more information.
103
Resources
Refer to the HHS Special Topics in Health Information Privacy webpage for information on:
● Cloud computing
● Mobile apps
● HIPAA regulation history
Table 1. HIPAA Privacy, Security, and Breach Notification Resources
For More Information About… Resource

Covered Entities Covered Entity Guidance
CMS.gov/Regulations-and-Guidance/
Administrative-Simplification/HIPAA-ACA/
Downloads/CoveredEntitiesChart20160617.pdf
Fast Facts
HHS.gov/hipaa/for-professionals/covered-
entities/fast-facts
Business Associates Contracts
HHS.gov/hipaa/for-professionals/covered-
entities/sample-business-associate-agreement-
provisions
HHS.gov/hipaa/for-professionals/faq/business-
associates
Communicating with a Patient’s Family, Friends, HHS.gov/sites/default/files/provider_ffg.pdf
or Others Involved in the Patient’s Care HHS.gov/hipaa/for-professionals/special-topics/
mental-health
Emergency Situations: Preparedness, Planning, HHS.gov/hipaa/for-professionals/special-topics/
and Response emergency-preparedness
PHI Disposal HHS.gov/sites/default/files/ocr/privacy/hipaa/
enforcement/examples/disposalfaqs.pdf
Privacy and Security of Electronic Health HealthIT.gov/topic/privacy-security-and-hipaa
Records (EHR)
Model Notices of Privacy Practices HHS.gov/hipaa/for-professionals/privacy/
guidance/model-notices-privacy-practices
104
Table 1. HIPAA Privacy, Security, and Breach Notification Resources (cont.)
For More Information About… Resource

Omnibus HIPAA Final Rule (2013 Modifications GPO.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-
to the HIPAA Privacy, Security, Enforcement, and 01073.pdf
Breach Notification Rules)
Security Rule Guidance Material HHS.gov/hipaa/for-professionals/security/
guidance
Training Materials HHS.gov/hipaa/for-professionals/training
Table 2. Hyperlink Table
Embedded Hyperlink Complete URL

Code of Federal Regulations (CFR) Title 45, https://www.ecfr.gov/cgi-bin/text-idx?SID=2e74e
Section 160.103 e451fc72a29cdf7e67af5219ce6&mc=true&node
=pt45.1.160&rgn=div5#se45.1.160_1103
HHS Special Topics in Health Information https://www.hhs.gov/hipaa/for-professionals/
Privacy special-topics
HIPAA Breach Notification Rule https://www.hhs.gov/hipaa/for-professionals/
breach-notification
HIPAA Compliance and Enforcement https://www.hhs.gov/hipaa/for-professionals/
compliance-enforcement
HIPAA Covered Entities and Business https://www.hhs.gov/hipaa/for-professionals/

Associates covered-entities
HIPAA Guidance https://www.hhs.gov/hipaa/for-professionals/
privacy/guidance
Medicare Learning Network® Product Disclaimer
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S.
Department of Health & Human Services (HHS).
105
Appendix S
Appendix S
Confidentiality Agreement
Vanderbilt University Medical Center (VUMC) has legal and ethical responsibilities to safeguard the
privacy of its employees, students, and patients and their families and to protect the confidentiality of
protected health information (PHI) and all other types of confidential information (collectively, “Confidential
Information” as further defined below). Members of the VUMC community to which this Confidentiality
Agreement applies include but are not limited to a:
 Workforce Member: an individual performing work on behalf of VUMC and under the direct
control of VUMC, whether or not the member is employed by VUMC. Examples include staff;
faculty; temporary agency workers; students; contractors; and volunteers.
 Trusted Role: a Workforce Member whose job duties require access to VUMC Confidential
Information in order to provide legal or risk management advice to the institution, perform audit or
review duties or investigations or to provide support for an information system. An individual in a
Trusted Role is held to a higher standard of personal integrity, professionalism and judicious
precaution when accessing Confidential Information.
 Extended Community Member: an individual who is present on VUMC premises or accessing
information resources at VUMC for a specific treatment, payment, or health care operation, or
other authorized purpose allowed under the Health Insurance Portability and Accountability Act
(HIPAA) such as a third party payer representative, a visitor for a guided tour or observation
experience, media or vendor representatives, or other health care providers involved in a
patient’s continuum of care.
 Business Associate: a person or entity, other than a Workforce Member, that performs certain
functions or activities on behalf of, or provides certain services to, VUMC that involve the use,
disclosure, creation, receipt, maintenance or transmission of PHI.
VUMC’s Confidential Information includes any and all of the following categories:
 Patient information (or PHI) including demographic, health, and financial information, pictures and
videos (in paper, verbal, observed or electronic form regardless of how it is obtained, stored,
utilized, or disclosed);
 Information pertaining to members of the VUMC Workforce or Extended Community(such as
social security numbers, banking information, salaries, employment records, student records,
disciplinary actions, etc.);
 VUMC information (such as financial and statistical records, academic or research funding,
strategic plans, internal reports, memos, contracts, peer review information, communications,
proprietary information including computer programs, source code, proprietary technology, etc.);
 Third-party information (such as insurance, business contracts, vendor proprietary information or
source code, proprietary technology, etc.); and
 Patient, research, academic program, or other confidential or proprietary information heard or
observed by being present on VUMC premises.
As a member of the VUMC community I agree to conduct myself in strict conformance with all applicable
laws and with VUMC policies governing Confidential Information. I understand and agree that measures
must be taken so that all Confidential Information captured, maintained, or utilized by VUMC and any of its
off-site clinics or affiliated entities is accessed only by authorized users. These obligations apply to
Confidential Information in any form, e.g., written, electronic, oral, overheard or observed.
Page 1 of 3 (MC 9967) 08/2019

106
As a condition of and in consideration of my use, access, maintenance and/or disclosure of Confidential
Information, I agree that:
1. I will access, use, maintain and disclose Confidential Information only as authorized and needed
to perform my assigned job duties. This means, among other things, that I:
a) will only access, use, and disclose Confidential Information that I have authorization to
access, use, and disclose in order to perform my job duties;
b) will not in any way access, use, divulge, copy, release, sell, loan, review, alter, or destroy any
Confidential Information except as properly and clearly authorized within the scope of my job
duties and in accordance with all applicable VUMC policies and procedures and with all
applicable laws;
c) will report to the Privacy Office or my supervisor any individual’s or entity’s activities that I
suspect may compromise the privacy or security of VUMC’s Confidential Information or
otherwise fail to conform to VUMC policies and procedures;
d) understand my violation of my obligations regarding Confidential Information, particularly PHI,

could expose me to legal sanctions.
2. If I am granted access to VUMC electronic systems, including email, I am the only person
authorized to use the individual user identification names and passwords or access codes
assigned to me. I agree to the following:
a) I will safeguard and not disclose my individual user identification passwords, access codes or
any other authorizations that allow me to access VUMC Confidential Information to anyone
including my manager, supervisor, IT Support staff or any other person who is not authorized
to have this information.
b) I understand that if I am in a Trusted Role I will be held to a higher standard of personal

integrity, professionalism and judicious precaution when accessing Confidential Information.
c) I will not request access to or use any other person’s passwords, access codes or other
authorizations.
d) I accept responsibility for all activities undertaken using my passwords, access codes and
other authorizations.
e) It is my responsibility to log out of any system to which I have logged on. I will not under any
circumstances leave unattended a computer to which I have logged on without first either
locking it or logging off the workstation.
f) If I have reason to believe that the confidentiality of my passwords or access codes have
been compromised, I will immediatelyreport this to the VUMC Help Desk, Privacy Office and
my supervisor, and I will immediately change my password.
g) I understand that my user identification will be deactivated at such time when I am no longer
a VUMC Workforce Member, Extended Community Member, or Business Associate; or when
my job duties no longer require access to the computerized systems.
h) I understand that VUMC has the right to conduct and maintain an audit trail of all accesses to
Confidential Information, including, but not limited to the machine name, user, date, and data
accessed and that VUMC may conduct a review of my system activity at any time and without
notice in order to monitor appropriate use.
Page 2 of 3 (MC 9967) 08/2019
107
i) I understand and accept that I have no individual rights to or ownership interests in any
Confidential Information referred to in this agreement and that therefore VUMC may at any
time revoke my passwords or access codes.
j) I understand that if I access or maintain Confidential Information on any personal device I

must abide by all VUMC mobile device management policies.
k) I will not forward Confidential Information including but not limited to PHI, pictures or videos to
my personal email or to any social media accounts.
l) I understand that it is my responsibility to be aware of VUMC Information Management

policies, applicable Human Resource policies, and other policies that specifically address the
handling of Confidential Information and misconduct that may warrant immediate discharge
or other disciplinary action.
m) I understand that in addition to protecting Confidential Information I am also required to be

aware of the Electronic Communications and Information Technology Resources policy and
to abide by all of its requirements regarding the appropriate use of VUMC computer systems.
n) My obligation to safeguard VUMC Confidential Information, including PHI, continues after I

am no longer affiliated with VUMC.
My signature below indicates that I have read, accept, and agree to abide by all of the
requirements described above. I acknowledge that any violation of these requirements may result
in disciplinary measures up to and including termination of employment and/or affiliation with
VUMC.
Print Name: _ Job Title:
Signature: ___________________________________ Date:
Department/School or Company: _ _
Page 3 of 3 (MC 9967) 08/2019
108
D E PA RTM E N T O F H E A R I N G & S P E EC H S C I E N C E S Appendix T
Health
& Safety
RESOURCES
The VUMC/Vanderbilt Community is akin to an extended

family. We have a strong commitment to caring and
supporting one another. This philosophy extends to and
includes students. Because of this, there are many resources
and support services available, including supports when
unforeseen situations arise.
We hope your graduate career is smooth sailing. But, things

can happen. Situations change. Just being in school can cause
stress, aggravating underlying physical or emotional problems.
If you start to feel your health, safety, or stability is in trouble, don’t try to push through on your own. Getting the assistance you
need sooner rather than later is the key to getting your problem solved and your life back on track. Here are some resources that
you might find helpful. There are multiple levels of support that can be accessed, including crisis situations.
If you encounter harassment or discrimination of any kind, or if you are having trouble with relationships, class work, finances,
or physical or emotional distress, please talk to the Vice Chair of Graduate Studies (Dr. Todd Ricketts), your faculty advisor, or
another trusted member of the department. We are all committed to supporting your needs and your safety.
For concerns with research or clinical supervisors that can not be resolved by speaking directly to the individual, please reach
out to Drs. Duff, Fino-Szumski, or Ricketts, or other trusted faculty or staff. They can guide you toward the best resources to help
you. We also respect your privacy. Any and all personal information is yours and is, by law, protected. Although your faculty and
staff are always ready to listen, please know that you do not have to share any personal details with anyone in the department
if you do not wish to do so. You can seek support directly from the
resources provided below. However, if you choose to report your
concerns to a department employee, we will not share personal
information you disclose to us with anyone else unless required to do
so by law.
In the case of sexual or other harassment, please be aware that staff

and faculty are obligated to report your concerns to VUPD, Title IX
and Discrimination Office, and/or the School of Medicine. Please
understand that when these offices are informed, they take the lead in
supporting you. Because of this, the department is no longer directly
involved in the process – we often receive no information unless it is
provided to us by the student. Likewise, if you go directly to one of
the resources below, and we encourage you to do so when necessary,
it is important to note that the department will not be notified
unless further information from us is required. You are free to report
information to the department and/or advisor, and you are also free
to not do so if you want the information to remain confidential. But,
the VUPD, Title IX and Discrimination Office, and/or the School of
Medicine will not automatically provide information to the department
or advisor.
109
PHYSICAL SAFETY AND EMOTIONAL HEALTH
DIRECT Download site for SafeVU cell phone app:
RESOURCES https://police.vanderbilt.edu/services/safevu.php
University Counseling Center

(615-322-2571), x 22571
https://www.vanderbilt.edu/ucc/
Project Safe Center (24/7 hotline available, 615-322-SAFE)

http://vanderbilt.edu/projectsafe/staff/
Student Care Coordination Network

https://www.vanderbilt.edu/studentcarenetwork/
COMPLAINT PROCEDURES AND INFORMATION

FOR FACULTY, STAFF, AND STUDENTS
Sexual Harassment/Misconduct
https://www.vanderbilt.edu/eeo/sexual-harassment/
Student handbook (Chapter 7)

Sexual misconduct and intimate partner violence
https://www.vanderbilt.edu/student_handbook/sexual-misconduct/
NON-EMERGENCY
ACCESS AND DISCRIMINATION VUPD non-emergency

615-322-2745, x22745
Title IX and Student Discrimination Office
(615)343-9004, x39004 Nashville police non-emergency
https://www.vanderbilt.edu/title-ix/ 615-862-8600
Student Access Services

(615) 343-9727, x39727 IN AN EMERGENCY
https://www.vanderbilt.edu/student-access/ On-campus to the VUPD
615-421-1911 or x11911
Equal Employment Opportunity Office
(615)343-9336, x39336 Off-campus dial 911
https://www.vanderbilt.edu/eeo/ Suicide Prevention Lifeline
1-800-273-8255
110

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2022-2023

GRADUATE STUDIES CLINICAL HANDBOOK

VANDERBILT UNIVERSITY MISSION...................................................................................................5

VUMC STATEMENT OF PURPOSE.........................................................................................................5

VUMC STRATEGIC COMMITMENTS...................................................................................................6

THE VANDERBILT PATIENT & FAMILY PROMISE............................................................................7

DEPARTMENT OF HEARING AND SPEECH SCIENCES MISSION................................................7

RESPONSIBILITIES OF STUDENT CLINICIANS...............................................................................10

Register for Clinical Courses.................................................................................................................10

Provide Documentation of Health Screenings...................................................................................11

Complete Required Training.................................................................................................................11

Initial Compliance Training..............................................................................................................11

eStar Training (EMR).........................................................................................................................11

4th Year Externship............................................................................................................................14

EXTERNAL CLINIC PLACEMENTS......................................................................................................16

STUDENT USE OF MEDICAL RECORDS............................................................................................18

Student Access to Electronic Medical Records-Departmental Policy.............................................19

SERVICES FOR STUDENTS WITH DISABILITIES............................................................................23

CENTER FOR STUDENT WELLBEING................................................................................................23

A. VUMC Non-Discrimination and Accessibility Notice.....................................................................25

B. CALIPSO Evaluation Form - Audiology.............................................................................................26

C. CALIPSO Evaluation Form - Speech-Language Pathology..............................................................30

D. Practicum Planning Form.....................................................................................................................33

E. CALIPSO Clock Hour Form - Audiology...........................................................................................34

F. CALIPSO Clock Hour Form - Speech-Language Pathology.............................................................35

G. CALIPSO Supervisor Feedback Form.................................................................................................36

H. CALIPSO Student Evaluation of Off-Campus Placement Form.....................................................40

J. Eye Protection and Surgical Mask Reminders/Masking and Workplace Guidance.......................48

K. Universal Masking Guidance...............................................................................................................50

L. CALIPSO Knowledge and Skills Acquisition - Audiology................................................................53

M. CALIPSO Knowledge and Skills Acquisition - Speech-Language Pathology...............................66

N. Request for 4th-Year Externship Form...............................................................................................85

O. Request for SLP Externship Form........................................................................................................86

P. VUMC Patient Rights and Responsibilities.........................................................................................89

Q. VUMC Notice of Privacy Practices.....................................................................................................90

S. VUMC Confidentiality Agreement....................................................................................................106

T. Health and Safety Resources................................................................................................................109

Mary Sue Fino-Szumski, Ph.D., M.B.A., CCC-A

VUMC Non-Discrimination and Accessibility Notice is included in Appendix A of this handbook.

VANDERBILT UNIVERSITY MISSION

VUMC STATEMENT OF PURPOSE

VUMC STRATEGIC COMMITMENTS

• I make those I serve my highest priority.

Vanderbilt University Medical Center is committed to excellence. We will:

DEPARTMENT OF HEARING AND SPEECH SCIENCES MISSION

To achieve the above goals, supervisors:

Register for Clinical Courses

M.S. Speech-Language Pathology Program – 5 semesters

Year Semester Course Credits

M.S. Speech-Language Pathology Program – 6 semesters

Year Semester Course Credits

Clinical Doctorate (Au.D.) in Audiology – 11 semesters

Year Semester Course Credits

Complete Required Training

Initial Compliance Training

eStar Training (EMR)

DEPARTMENTAL REQUIREMENTS FOR CLINICAL EDUCATION

Scope of Practice in Audiology: https://www.asha.org/policy/SP2018-00353/American Speech-Language-Hearing

Scope of Practice in Speech-Language Pathology: https://www.asha.org/policy/SP2016-00343/ American Speech-

Semester/Year Expected Clinic Time Per Week

ASHA Code of Ethics https://www.asha.org/Code-of-Ethics/

STUDENT USE OF MEDICAL RECORDS

Student Access to Electronic Medical Records – Departmental Policy