STUDENT HEALTH SERVICES ADVISORY COMMITTEE
2013 STUDENT HEALTH SERVICES SURVEY
Survey for Provost/Vice President of Academic Affairs
A number of academic programs in the California State University (i.e. nursing, counseling, kinesiology,
physical therapy, public health, etc.) offer health-related courses and programs that may include student
practicums, internships or faculty practices that provide health-related services to the campus community,
the public, or both.
For the purpose of this survey the services are listed below, and educational programs are defined as any
services performed as part of an academic program leading to licensure in a health services profession,
including services provided by students from other institutions. Check “other service(s)” for services not
included on the list.
1. Please identify the health services provided by academic departments as part of educational
programs on your campus and the communities they serve (check all that apply).
Public Students
Health Services or Clinics
Physical Medicine and Rehabilitation
Psychological Services
Audiology
Physical Therapy
Sports Medicine and Health Care for Student-Athletes
Occupational Medicine
Health Educational Program(s) (specify programs) :
Other Service(s) (specify services):
Both



























In order to help address and manage risk related to these circumstances on your campus, please
answer the following:
Yes
No
Unsure
2. Within the past two years, has the President or the Provost’s Office
surveyed all potentially relevant Academic Departments research projects
and Extended Education offerings in order to identify all health-related
programs that include or offer department-sponsored clinics, students
practicum/internship programs, and/or faculty practices?
3. Is the nature and scope of all such health related academic programs
known to the President, Provost, Risk Manager &/or similar responsible
administrators?






4. Please list the nature, scope, and source of clientele for each of these kinds of programs on your
campus.
Yes
No
Unsure



6. If yes, is there a mechanism for accounting for and monitoring the collection
and expenditure of these funds?



7. Is there a standard mechanism for oversight and monitoring of professional
licensing and credentialing and privileging requirements for the supervisors
and providers of such services on your campus?



No
Unsure
10. Notification of clients whenever services are received from un-licensed or
un-credentialed students or interns?









11. Scope and method of supervision of students/ interns consistent with legal
and standard of care requirements?



12. Record keeping, including format; review and countersigning requirement;
storage, retention, and destruction of records; records release;
confidentiality, etc.



13. Referral mechanisms and follow-up of clients whose need for services
exceed the scope, expertise, or duration of your program?



No
Unsure


5. Do these programs charge for or receive external funding for services
rendered and/or for consultations?
Do the programs have written policies, procedures, documentation, and
oversight mechanisms that address the following?
Yes
8. Defined scope and limitations of services
9. Sufficient expertise to offer the service
14. Do these programs have liability insurance policies (separate from the CSU
Risk Pool) to cover associated risk?
15. If yes, please provide the details of the coverage.
Yes
16. Do you provide services that would be covered by HIPAA or the HITECH
ACT?
COMMENTS

STUDENT HEALTH SERVICES ADVISORY COMMITTEE
2013 STUDENT HEALTH SERVICES SURVEY
Survey for the Vice President for Student Affairs
1. What is the date and duration of your Student Health Center’s most recent Accreditation Association
for Ambulatory Health Care (AAAHC) accreditation?
Yes
2. Does your Student Health Center provide services that would be covered
by HIPAA or the HITECH ACT?

No
Unsure


3. Are there any changes or updates you would like to see in Executive Order 943: Policy on University
Health Services? If so, please explain
Psychiatric Services
The Chancellor’s Office is interested in information regarding the provision of psychiatric services. Please
answer for your campus, even your psychiatrist is located in your Counseling Services.
4. Do you have a psychiatrist providing services on your campus?
4(a). Does the psychiatrist provide serves to Student Health Center, Counseling Center or both?
4(b). If yes, how many hours per week in each location?
5. How much do you charge for this service? (If you have more than one psychiatrist, please list the
information below separately for each.)
6. If your psychiatrist is a contractor, how many hours do you contract for?
7. If your psychiatrist is a contractor, how much do you pay per hour?
8. If your psychiatrist(s) is an employee, how many FTE do you have and what time base, e.g. 1.0 FTE,
10 month.
9. If the psychiatrist is an employee, what is his his/her salary?
COMMENTS: