STUDENT CLINICIAN HANDBOOK
BASTYR CENTER FOR NATURAL HEALTH
TEAM CARE
2003-2004
Student Clinician Handbook, 2003-2004
WELCOME…
Welcome to the Bastyr Center for Natural Health! You are about to embark on a very
exciting and wonderful part of your training at Bastyr University. The Bastyr Center for
Natural Health is expected to provide more than 35,000 patient visits this year. The
services of each program and the integration between programs offer some of the best
natural medicine care anywhere! The staff and faculty of the Center for Natural Health
are excited about your entry into the clinical portion of your training and look forward to
your unique and important contributions.
The mission of the Bastyr Center for Natural Health is to create an extraordinary
environment committed to excellence in health care and clinical education that assists and
empowers individuals and the community to achieve better health and a higher quality of
life.
The Vision of Bastyr University
Bastyr University will be the world’s leading academic center for advancing knowledge
in the natural health sciences.
The Mission of Bastyr University
We educate future leaders in the natural health sciences that integrate mind, body, spirit
and nature. Through natural health education, research and clinical services, we improve
the health and well being of the human community.
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Student Clinician Handbook, 2003-2004
TABLE OF CONTENTS
WELCOME… ................................................................................................................... 2
TABLE OF FIGURES ...................................................................................................... 5
CENTER ORGANIZATION CHART ........................................................................... 6
PURPOSE OF THE HANDBOOK ............................................................................... 10
DEPARTMENT OVERVIEWS .................................................................................... 11
PROGRAMS OF STUDY .............................................................................................. 13
CLINIC EDUCATION REQUIREMENTS ................................................................. 13
CLINIC ENTRY COURSES ......................................................................................... 16
SUMMARIES OF CLINIC REQUIREMENTS .......................................................... 19
INTERIM CLINIC ......................................................................................................... 30
PRECEPTORSHIPS ...................................................................................................... 32
AOM PROGRAM CHINA EXTERNSHIP ................................................................. 35
STUDENT ACADEMIC ADVISING ........................................................................... 36
STUDENT REGISTRATION FOR CLINIC SHIFTS ............................................... 38
CLINIC ATTENDANCE REQUIREMENTS ............................................................. 40
ABSENCE AND SUBSTITUTION ............................................................................... 42
SANCTIONS ................................................................................................................... 44
LOSS OF CREDIT, SUSPENSION, DISMISSAL ...................................................... 45
CLINIC GRIEVANCE POLICY FOR STUDENTS .................................................. 46
CLINIC GRIEVANCE POLICY FOR PATIENTS .................................................... 47
PERFORMANCE EVALUATIONS ............................................................................. 49
GRADING ....................................................................................................................... 50
CLINIC PROCEDURES, POLICIES AND PROTOCOLS....................................... 75
PATIENT SCHEDULING ........................................................................................... 119
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Student Clinician Handbook, 2003-2004
BASTYR UNIVERSITY RESIDENCY PROGRAM................................................ 138
CLINICAL COMPETENCIES ................................................................................... 141
APPENDICES ............................................................................................................... 212
CLINIC CONTRACT .................................................................................................. 213
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Student Clinician Handbook, 2003-2004
TABLE OF FIGURES
Figure 1 Center Organization Chart .................................................................................... 6
Figure 2 AOM Clinical Program Schedules ..................................................................... 21
Figure 3 ND Clinical Program Schedules ......................................................................... 25
Figure 4 Patient Care CPT Coding Worksheet ............................................................... 115
Figure 5 Physical Exam Elements Required Should be Circled Below by Doctor ........ 117
Figure 6 AOM Clinical Competency One ..................................................................... 146
Figure 7 AOM Clinical Competency Two...................................................................... 148
Figure 8 AOM Clinical Competency Three.................................................................... 150
Figure 9 AOM Clinical Competency Four ..................................................................... 152
Figure 10 AOM Clinical Competency Five .................................................................... 154
Figure 11 AOM Clinical Competency Six...................................................................... 156
Figure 12 AOM Clinical Competency Seven ................................................................. 158
Figure 13 ND Secondary Clinical Competencies ........................................................... 164
Figure 14 ND Primary Clinical Competencies ............................................................... 168
Figure 15 ND Primary Clinical Competencies - Conditions .......................................... 174
Figure 16 ND List of Physical Exams to be Performed by Clinicians ........................... 176
Figure 17 ND Physical Medicine Secondary Competencies .......................................... 178
Figure 18 ND Physical Medicine Primary Competencies .............................................. 182
Figure 19 ND Counseling Clinical Competencies .......................................................... 186
Figure 20 Dispensary Clinical Competencies ................................................................. 190
Figure 21 Product Analysis Sheet ................................................................................... 192
Figure 22 Homeopathy Clinical Competencies (Optional) ............................................ 196
Figure 23 Requirements to enroll in optional homeopathy specialty shifts.................... 196
Figure 24 Homeopathy Clinical Competencies for Secondary Student Clinicians ........ 196
Figure 25 Homeopathy Clinical Competencies for Primary Student Clinicians ............ 197
Figure 26 ND Clinical Competencies for Visceral Manipulation .................................. 200
Figure 27 Nutrition Learning Objectives and Competencies for Secondary Clinicians . 202
Figure 28 Nutrition Learning Objectives and Competencies for Primary Clinicians ..... 204
Figure 29 Clinical Faculty by Program ........................................................................... 210
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Student Clinician Handbook, 2003-2004
CENTER ORGANIZATION CHART
Figure 1 Center Organization Chart
Phone extension
Bastyr Center For Natural Health……………………………………………206-834-4100
Second Floor Appt. Desk ……………………………………………………………...4101
Third Floor Appt. Desk ….…………………………………………………………….4102
Practitioner Care Desk ………………………………………………………………...4190
ND Resident Pager (urgent calls from patients only) ……………………….206-200-7067
Dispensary……….…………………………………………………………………….4114
Laboratory ………………………………………………………………..……………4113
Marketing ……………………………………………………………………………...4117
Medical Questions Line (internal voicemail access only) …………………………….5999
Medical Records ………………………………………………………………………4151
Dean of Clinical Affairs—Jane Guiltinan, ND.……………………………………….4105
Executive Asst. to Dean of Clinical Affairs—Lynne McCutchen ……4178
Interim Medical Director—Jamey Wallace ND.……………………………...4141
Administrative Coordinator—Alyse Aiello …………………………..4119
Clinic Program Coordinator—Lillian Rea ……………………………4106
Product Review Coordinator—Paul Dompe ND.……………………..4156
ND Clinical Department Coordinator—John Hibbs, ND..……………4158
ND Clinical Faculty:
Karim Abdullah, ND (Core) .……………………………………4127
Michelle Antonich, ND, LM (Adjunct) …………………………5143
Kevin Conroy, ND (Core) ………………………………………4134
Jill Fresonke, ND (Adjunct) …………………………………….5145
Keith Grieneeks, PhD (Core) …………………………………..4155
Mark Groven, ND (Core) ……………………………………….4112
Maryann Ivons, ND (Adjunct) ………………………………….5203
Eric Jones, ND (Core) …………………………………………..4129
Mark Lamden, ND (Adjunct) …………………………………Offsite
Richard Mann, ND (Core) ………………………………………4135
Melissa McClintock, ND (Core) ………………………………..4184
Nancy Mercer, ND (Adjunct) …………………………………...5204
Steve Milkis, ND (Adjunct) …………………………………….4148
Jana Nalbandian, ND (Core) ……………………………………4170
Dean Neary, ND (Adjunct) ……………………………………Offsite
Andrew Parkinson, ND (Core) ………………………………….4123
Brian Peters, ND (Adjunct) ……………………………………..5206
Kasra Pournadeali, ND (Adjunct) …………………………….Offsite
Dirk Powell, ND (Adjunct) ……………………………………..5530
Bill Roedel, PhD (Core) ………………………………………....5127
Amy Turnbull-Hueffed, ND (Adjunct) …………………………4149
ND Residents:
Cristopher Bosted, ND (1st year) ……………………………4168
Letitia Cain, ND (1st year) …………………………………..4171
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Student Clinician Handbook, 2003-2004
Kevin Connor, ND (2nd year) ……………………..206-925-4661
Christian Dodge, ND (1st year) ……………………206-925-4660
Heather Greenlee, ND (Research Fellow) …………………..4160
Kasia Hopewell, ND (1st year) ………………………………4128
Maide Romero, ND, LAc (2nd year) ………………206-925-4662
Kathleen Speers, ND (1st year) ……………………………...4172
Wendy Weber, ND (Research Fellow) ……………………..5105
Phoebe Yin, ND (1st year) …………………………………..4153
AOM Clinical Department Coordinator—Steve Given, L.Ac...………4179
AOM Clinical Faculty:
Benjamin Boonchai Apichai, LAc (Adjunct) …………………...5704
Qiang Cao, LAc (Core) …………………………………………4197
Terry Courtney, LAc, Department Chair ……………………….4162
Wei Yi Ding, LAc (Core) ………………………………………5535
James Dowling, LAc (Adjunct) …………………………………5826
Matthew Ferguson, LAc (Adjunct) ……………………………..5791
Todd Hymel, LAc (Adjunct)…………………………………….5109
Kayo King, LAc (Adjunct) ……………………………………..5741
Chongyun Liu, LAc (Core) ……….…………………………….4196
Tong Lu, LAc (Adjunct) ………………………………………..5703
Yuanming Lu, LAc (Adjunct) ………………………………….5567
Rosey (Xin Dong) Ma, LAc (Adjunct) …………………………5116
Andy McIntyre, LAc (Core) …………………………………….4125
Kyo (Richard) Mitchell, LAc (Core) ……………………………4176
Michele Najera, LAc (Adjunct) …………………………………5121
Janna Rome, LAc (Adjunct) ……………………………………5705
Mark Tibeau, LAc (Adjunct) ……………………………………5119
Angela Tseng, LAc (Adjunct) …………………………………..4175
Jianli Wang, LAc (Adjunct) ………………………………….…5117
Yajuan Wang, LAc (Core) ………………………………………5561
Ying Wang, LAc (Core) ………………………………………..4122
AOM Residents:
Kelly Neu, LAc ……………………………………………..4174
Jasmine Patel, LAc ………………………………………….4187
Sue Yang, LAc ………………………………………………4192
Nutrition Clinical Department Coordinator—Jim Gallagher, MS, RD.4188
Nutrition Clinical Faculty:
Ann Fittante, MS, RD, CDE ……………………………………5126
Jeanne Cullen, MS, RD, CDE …………………………………..5108
Dir. Ofc. of Grad. and Community Medicine—Gary Garcia, MD ……4124
Placement/Preceptor Coordinator—Jeanne Kinley Deller ……………4103
Site Coordinator—Ione Turner ……………………………………….4104
Clinic Administrator—Lisa Hopkins …………………………………………4118
Lab Manager—Joseph Syersak, Ph.D………..…………………..……4137
Medical Lab Technician—Michael Donelson ……………………4113
Medical Lab Technician—Nally Berg ……………………………4113
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Student Clinician Handbook, 2003-2004
Center Receptionist—Ann Thurman Burnell …………………………5500
Patient Services Manager—Martin Imbach …………………………..4108
Asst. Patient Services Mgr.—Himena Viner ……………………..4173
MOA 2:
Harriet Ann Majors ……………………………………………5301
Zandi Salstrom …..……………………………………………5312
Zoe DePaz …...………………………………………………..5132
Practitioner Care Asst. —Joseph Yurgevich ...……………………4142
Med. Records Mgr/HIPAA Compliance Officer—Anthony Amos …..4140
File Clerk—Jennifer Barrett ………………………………….5314
Medical Records Asst.—Katie Hunt …………………………5309
Dispensary Manager—Ann Busch ……………………………………4145
Dispensary Supervisors:
Barbara Nims ………..…………………………………………….5848
Kelly Uusitalo ……………………………..………………………4109
Lead Dispensary Assistants:
Gillian Mamacos ………………………………………………5767
Michelle Seligman …………………………………………….5513
Dispensary Assistants:
Sharon Dennehy …………………………………………..4114
Donna Grisham ……………………………………………5516
Kathleen Jancoski …………………………………………5110
Chris Johnson ……………………………………………..5118
Andi Matack ………………………………………………5125
Katania Vanegoni …………………………………………5111
Lisa Wada …………………………………………………5113
Greg Yasuda ………………………………………………4114
Chinese Herbal Med. Dispensary Manager—Allen Sayigh, LAc...…. .4121
CHM Dispensary Assistants:
Renata Chung, LAc…..………………………………….. ..5149
Matt Ferguson, LAc..…..………………………………….5791
Monica Sweet, LAc.......…………………………………. .5148
Mercy Yule, LAc.….…..…………………………………..5601
Operations Manager—Jennifer Mulford ……………………………..4130
Asst. Operations Manager—Steevie Bereiter …………………….4157
Operations Staff:
Joseph Chodykin ………………………………………….5128
Mike Hernandez …………………………………………..4110
Garrett Zwar ………………………………………………5115
Business Office Manager—Bethany McMahan Moreland …………..4164
Assistant Manager/Medical Biller—Deana Gantar ……………….4100
Insurance Specialist—Kat Terran …………………………4126
Insurance Specialist—Jane Wheeler ………………………4177
AR/Billing Assistant—Britta Petrelli ……………………..4186
Collections Specialist—Kathryn Tilson …………………..4165
Business Dept. Helpline …………………………………..4183
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Student Clinician Handbook, 2003-2004
Accounting and Budget Manager—Christine Shields ………………..4150
Research Department:
Senior Research Scientist—Leanna Standish, ND, PhD, LAc ……...425-602-3166
Assistant Research Professor—Wendy Weber, ND ………………………4139
Research Assistant—Heather King……………………………………4139
Project Manager—Jung Kim ……………………………………………...4139
Postdoctoral Fellow—Jessica Leonard, ND, LAc ………………………..4139
Marketing Department:
Marketing Director—Laura Biggers ………………………………………….4117
Marketing Coordinator—Dawn MacDonald ……………………………..4163
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Student Clinician Handbook, 2003-2004
PURPOSE OF THE HANDBOOK
The purpose of the Student Clinician
Handbook is to outline the policies,
standards, and guidelines for you to
function effectively during your clinical
rotations. The handbook is designed to
provide overall guidelines and
requirements for student clinician
performance and conduct. While it is
expected that you follow this handbook
diligently, there may be times when
additional information and guidelines are
provided which add to or complement
what is already in the handbook.
Student clinicians are responsible for
knowing and adhering to all of the
information in this handbook.
Students should keep all completed
forms and copies of clinic related
paperwork in this handbook. Originals
are to be turned in to the clinic
registration staff. The handbook is
designed to be a helpful guide and a
means of record keeping. It is important
that you use it in this manner.
This handbook supercedes all previous
versions and editions. Policies and
procedures contained in this document
are subject to change at any time. The
clinic contract found in the Appendix
(page 213) must be signed by each
student and a signed copy brought to the
registrar’s office prior to eligibility for
entrance into the clinic. All student
clinicians are subject to the regulations
set out in this edition of the Student
Clinician Handbook. While previously
completed sign offs need not be
repeated, all further sign offs must be
completed according to this edition of
the Student Clinician Handbook.
The Student Clinician Handbook is
divided into sections as outlined in the
Table of Contents. Part I provides clinic
education requirements. Part II provides
specific information on evaluations,
policies, and standards. Part III contains
information on clinic competencies and
forms that will be needed during the
clinical rotations.
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Student Clinician Handbook, 2003-2004
education here at Bastyr Center for
Natural Health:
DEPARTMENT OVERVIEWS
ACUPUNCTURE AND ORIENTAL
MEDICINE
“Alas, the way of healing is so profound.
It is deep as the oceans, and boundless as
the skies. How many truly know it?
When sages practiced medicine, they
were certain to have understood the laws
of nature and principles of disease, to
master diagnosis, to have been well
learned in herbal medicine, and to have
attained insights into human
relationships and individual
temperament. As a result, they delivered
their medicine in a thoroughly holistic
way.
The Acupuncture and Oriental Medicine
(AOM) Department was established in
1988. A new AOM wing of the Center
opened in 1993 to provide room for
continual growth in the department. In
addition, the Chinese Herbal Medicine
Dispensary opened in 1994 to provide
the full-time component for the Chinese
Herbal Medicine clinical training. In
Spring 1999, the AOM clinic was
relocated to the third floor of the Center.
The AOM clinic now has nine
acupuncture treatment rooms, two
Chinese herbal medicine consultation
rooms, four preview/review rooms, a
library, and a suite of clinical faculty
offices. The third floor is also home to
the CHM Dispensary. Students in the
AOM programs may currently
participate in patient care opportunities
at three off-site clinics: Rainier Park
Medical Clinic in South Seattle, High
Point Medical Clinic in West Seattle,
and Carolyn Downs Family Medical
Center in the Central District.
“The key to effective medicine is to
determine the cause and rectify the
imbalance of the Yuan [original] qi of
the body. Study the ancient medical
classics well. Follow the correct
treatment principles and perform your
healing with the utmost care and
attention. Conduct yourself with the
highest virtue and always have
compassion toward your patients. In this
way you will be outstanding in your
cures. This is the way of the sage
physician.”
Welcome to the beginning of your
journey.
Unique aspects of the AOM clinical
program include a strong case
management focus implemented as case
previews and reviews, inter-clinic multidisciplinary referrals (ND, Nutrition,
Physical Medicine, Homeopathy, etc.),
and supervision by highly
skilled/qualified acupuncturists and
Chinese herbalists in the region.
We hope that your clinical experience in
the AOM department is a rewarding one.
We would also encourage you to
consider the following quote from the
Nei Jing as a guide for your medical
AOM Clinical Program Mission
The AOM clinical program is designed
to integrate the rich history of traditional
Chinese medical methods with the study
of modern sciences and the
contemporary practice of acupuncture
and oriental medicine.
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Student Clinician Handbook, 2003-2004
diaeta, "daily fare." The emphasis of the
program, therefore, is to incorporate
physiological, biochemical,
socioeconomic, political and
psychological aspects of human nutrition
and physical activity in the preparation
of graduate students for roles as
professional nutrition consultants. A
unique emphasis on whole foods and
multicultural, political and ecological
dimensions of the diet offer career
preparation for food programs,
outpatient clinic settings, or independent
practices. The concepts of “food as
medicine” and diet as critical
components in healing are fundamental
to natural therapeutics, optimal health
and whole-person healing.
NATUROPATHIC MEDICINE
The naturopathic clinical program
provides training in general naturopathic
practice for naturopathic medical
students of Bastyr University. This
training comprehensively covers core
naturopathic modalities, including
general medicine, physical medicine,
homeopathy, and lifestyle counseling.
Naturopathic medical students at the
Bastyr Center for Natural Health
progress through their training in
observing, supporting, and then
managing roles. Each role assumes
increasing responsibility for patient care.
Prior to graduating, students are able to
safely, competently, and efficiently
direct all aspects of patient diagnosis,
treatment, and management in a general
care setting. Emerging from
naturopathic clinical training, each
clinician will exemplify the integration
of traditional naturopathic principles of
healing with conventional medical
knowledge and skills.. At the core of
this integration is the self-reflective and
self-empowered desire on the part of
each clinician to provide the highest
quality of care to each and every one of
their patients.
Nutrition Clinical Program Mission
The mission of the nutrition program of
the Bastyr Center for Natural Health is
to provide excellent training and prepare
students to become skilled nutrition
clinicians. Students will be able to
provide knowledge, skills, and expertise
necessary to help patients achieve and
maintain optimal health and healing
through informed food choices by
incorporating the program's whole,
natural foods philosophy.
Naturopathic Clinical Program
Mission
To train naturopathic physicians who are
imbued with an understanding of how to
clinically apply the healing power of
nature and the principles of naturopathic
medicine.
NUTRITION
The nutrition program is founded upon
the holistic origins of the Greek word
diaira (diet), "made of life," and Latin
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Student Clinician Handbook, 2003-2004
5. Must complete TB
screening/Hepatitis
immunization or waiver (see
page 85).
6. Must have a current CPR for
Health Care Providers card.
7. Must complete signed clinic
contract, which must be on file
with the registrar.
PROGRAMS OF STUDY
ACUPUNCTURE AND ORIENTAL
MEDICINE
The AOM Program currently runs three
clinical programs:
Masters of Science in
Acupuncture (MSA)
Masters of Science in
Acupuncture and Oriental Medicine
(MSAOM)
Certificate in Chinese Herbal
Medicine (CCHM)
Internship Status:
1. Must have completed 4
observation shifts.
2. Must be matriculated in the MSA
or MSAOM degree program and
have successfully passed all
required courses in the first 5
quarters of AOM and basic
science curriculum and be in
good academic standing.
3. Must have a current CPR for
Health Care Providers card.
4. Must have passed the CCAOM
Clean Needle Technique exam
and the AOM Clinic Entry exam
with a minimum score of 70%.
5. The Clinic Entry Exam may only
be attempted once per quarter. If
a second failure occurs, this will
require a meeting with the
student’s academic advisor in
consultation with the AOM
Program Chair. A learning
contract will be established
which may require a student to
retake a class(es) or other
remedial measures. Successful
completion of the learning
contract must be accomplished
before a retake. A third failure
places the student in academic
probation, which may lead to and
include dismissal from the AOM
program.
NATUROPATHIC MEDICINE
Doctorate Degree Program in
Naturopathic Medicine (ND)
NUTRITION
The Nutrition Program currently offers
two clinical programs:
Masters of Science in Nutrition –
Clinical Counseling track (MS)
Bachelors of Science – Didactic
Program in Dietetics (DPD)
CLINIC EDUCATION
REQUIREMENTS
AOM PREREQUISITES TO ENTER
CLINIC
Observation Status:
1. Must be matriculated into the
AOM program.
2. Must complete and demonstrate
passing grades in all required
first quarter AOM academic
classes.
3. Must complete and have a
passing grade in Clinic Entry.
4. Must complete a Washington
State Patrol criminal background
check.
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Student Clinician Handbook, 2003-2004
the ND Clinic Department
Coordinator (Center, 206-834-4100).
A copy of the current CPR/First Aid
card, or written record of the
approval to substitute equivalent
experience for the current CPR/First
Aid card, must be turned in to the
clinic registration office (Campus,
425-823-1300).
ND PREREQUISITES TO ENTER
CLINIC
1. Students must complete and achieve
competency in all required first and
second year classes of the 4-year
track or all required classes in the
first, second, and third years of the 5year track, prior to entering clinic.
Students must be in good academic
standing in order to begin the clinical
training portion of their program.
Questions about didactic
prerequisites for ND students should
be addressed to the Registrar’s
Office Advisor (Campus, 425-8231300).
6. Students must complete a
Washington State Patrol (WSP)
criminal background check. There is
no charge for this service. Forms will
be distributed to all students enrolled
in Clinic Entry II. Forms are also
available in the Registrar’s office.
Questions about the WSP
background check should be
addressed to the Registrar’s Office
(Campus, 425-823-1300).
2. Students must complete and achieve
competency in Clinic Entry I, or
equivalent course.
3. Students must complete and achieve
competency in Clinic Entry II, or
equivalent course. Clinic Entry II
includes a clinic entrance exam,
which the student must pass.
7. TB screening and Hepatitis
immunization forms/waivers will be
distributed during the
Physical/Clinical Diagnosis 3 Lab
course. Students must have
completed TB screening and
received Hepatitis B immunization
or signed a waiver for Hepatitis B
immunization. TB screening and
Hepatitis immunization questions
can be directed to the Lab Manager
(Center, 206-834-4100).
4. All Advanced Standing/Transfer
Students must meet all clinical
training requirements. Advanced
Standing/Transfer Students must be
in good academic standing.
Advanced Standing students will not
be granted waivers of any clinical
training credits, hours, or other
requirements.
8. A signed clinic contract, Appendix 1
of the Student Clinician Handbook
(see page 213), must be turned in to
the clinic registration office.
5. Students must have proof of
completion of a course equivalent to
the 49-hour Red Cross course
entitled “Emergency
Response/Professional Rescuers
Level C-CPR” or equivalent
experience. Questions about what
constitutes eligible equivalent
experience should be addressed to
9. All ND students must complete 22
hours of preceptor experience (one
completed credit of preceptorship)
prior to the start of their first quarter
in the clinic. Preceptor packets with
full instructions are available from
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Student Clinician Handbook, 2003-2004
the wall display outside of the
Registrar’s office and from the
Preceptor Coordinator. Questions
about preceptorships should be
addressed to the Preceptor
Coordinator (Center, 206-834-4100).
Students who do not register for
clinic in any given quarter will likely
delay their graduation. To apply for a
leave of absence from the University,
contact the Registrar’s Office
(Campus, 425-823-1300).
10. All ND students who started their
clinic during or after summer 2000
must be enrolled in at least one (1)
Patient Care shift during all quarters
in which they are clinic eligible. This
includes summer quarters as well as
the spring quarter before graduation.
Exceptions to this quarterly clinic
attendance requirement are reserved
for extenuating circumstances.
11. Clinic registration forms will be
placed in the main campus student
mailboxes of all clinic eligible
students. Clinic registration forms
must be turned in to the Registrar’s
office by the established deadline, as
listed on the form. If you are clinic
eligible and do not receive a clinic
registration form, contact the clinic
registration office immediately.
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Student Clinician Handbook, 2003-2004
j. To prepare students for entry into
the clinic.
CLINIC ENTRY COURSES
AOM CLINIC ENTRY
Prerequisite: AOM Enrollment
Credits: 2.0
Hours: 2.0/week 22 total hours
Required Text: Student Clinician
Handbook
2. Syllabus:
Week 1: Introduction, blood
borne pathogens
Week 2: Patient visit procedures
Week 3: Clinic tour
Week 4: Critical thinking and
assessment
Week 5: Critical thinking and
assessment
Week 6: Evaluation, assessment,
management, referrals
Week 7: Charting, privacy, ethics
Week 8: CNT, Risk management
Week 9: Clinical research
Week 10: Presentations
Week 11: Final.
(All classes are 2 hours.)
1. Course Objectives:
a. The student will gain a
perspective on clinic purpose and
function.
b. The role of the observer and
intern clinician will be clearly
defined.
c. The student will be introduced to
skills that will allow her/him to
become familiar with case
management, including charting.
d. The student will be introduced to
the paperwork and paper flow in
the clinic.
e. The student will know the role of
each person in the clinic structure
and how she/he will interact with
these people.
f. The student will learn the clinic
policies, procedures, protocols
and clinical education
requirements.
g. The student will be exposed to
the ethical and moral issues of
acupuncture and clinical practice
and how these issues relate to the
clinic as a whole and to each
person as an individual within
the clinic.
h. The student is encouraged to
continue to develop and broaden
her/his own personal philosophy
of AOM.
i. To provide the students with
exposure to and experience with
the medicine they are studying.
3. Course Requirements:
Course introduced in classroom
2.0 hr
First Office Call: Acupuncture
1.5 hr.
Second Office Call: Chinese Herbal
Med.
1.5 hr
Return Office Visits (1.0 hour each)
2.0 hr
2 case previews
1.0 hr
2 case reviews
1.0 hr
End of Quarter Class Session
2.0 hr
4. A clinic entry journal is required of
all students as well as a summary
statement of learning to be turned in
at the final class meeting.
5. Students will receive a CE tracking
sheet that will be record of the
requirements for the class. It will
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Student Clinician Handbook, 2003-2004
need to be initialed and dated where
appropriate and included in your
clinic entry journal.
6. Students must receive a grade of AC
or better in Clinic Entry.
b.
c.
7. The Student Clinician Handbook is
the required text for this class.
d.
e.
ND CLINIC ENTRY I
This course is registered and paid for the
1st quarter of the 1st year of the 4 and 5
year track and is to be completed by the
end of Spring Quarter of the first year.
Credits:
1.0
Hours:
14.5
1.
f.
Course Objectives:
a. To provide students with a wellrounded experience with the
Bastyr Center for Natural Health,
from a patient’s perspective. This
course is designed as an
experiential class for the student.
Students can choose not to
receive the recommended
treatment. A student can choose
to have a wellness program
designed if there are no specific
health concerns to be addressed,
or if the student prefers not to use
recommended treatments.
b. To provide the students with
exposure to and experience with
the medicine they are studying.
c. To prepare students for Clinic
Entry II, the next prerequisite for
entry into the clinic after
achieving competency in CE 1.
d. To expose students to basic
medical terminology
g.
h.
Students and Instructor:
4.0 hour
First Office Call:
1.5 hr
Return Office Call:
1.0 hr
Nutrition Specialty Clinic
1.0 hr
A second Return Office
Call either in Patient
Care, Nutrition, or a First
Office call in
Homeopathy 1.0 hr.
Counseling Session 3.0
(includes 3 visits - these
will be done at the
student counseling center
at the main campus)
3 case previews:
1.5 hr
3 case reviews:
1.5 hr
3. Each student will be required to
write three evaluative papers,
discussing their experience in the
clinic. These papers are to be turned
in to the CE I Instructor at the
quarterly and final meetings.
4. Students will receive a CE I tracking
sheet that will be a record of the
requirements for the class. It will
need to be initialed and dated where
appropriate.
5. The CE I instructor will meet with
the class as a whole during scheduled
one hour meetings at the beginning
of Fall, Winter and Spring Quarters
to answer questions and share
information pertinent to the class.
6. The class will meet with the
Instructor at the end of Spring
Quarter for a final discussion group.
Course tracking sheets, student
essay, and final examination are due
2. Course Requirements:
a. Quarterly and Final allclass meeting between
17
Student Clinician Handbook, 2003-2004
and should be turned in together at
this time.
e. The student will be introduced to
the paperwork and paper flow in
the clinic.
f. The student will know the role of
each person in the clinic structure
and how she/he will interact with
these people.
g. The student will learn the clinic
policies, procedures, protocols
and clinical education
requirements.
h. The student will be exposed to
the ethical and moral issues of
medicine and clinical practice
and how these issues relate to the
clinic as a whole and to each
person as an individual within
the clinic.
i. The student is encouraged to
continue to develop and broaden
her/his own personal philosophy
of Naturopathic Medicine.
ND CLINIC ENTRY II
1.
Prerequisites:
a. ND Clinic Entry I
b. The student in the four-year
program is required to have
completed all first year
courses and Fall and Winter
second year classes in order
to receive an AC in Clinic
Entry II. The student in the
five-year program is required
to have completed all 1st and
2nd year courses and all Fall
and Winter 3rd year courses
in order to receive an AC in
CEII.
2.
Credits:
3.
Hours: 3 hrs/week x 3 weeks; 9
hrs + 2 hr exam = 11 total hours
4.
Required Text: Student Clinician
Handbook
5.
a.
b.
c.
d.
1.0
Course Objectives:
The student will gain a broader
understanding of naturopathic
medicine as it relates to clinical
practice.
The student will gain a
perspective on clinic purpose and
function.
The role of the 3rd year student
clinician will be clearly defined
The student will be introduced to
skills that will allow her/him to
become familiar with case
management, including charting,
as performed at the Bastyr Center
for Natural Health.
6.
The student will be required to pass
a clinic entrance exam in order to
receive an AC in Clinic Entry II.
7.
Student must receive a grade of
achieved competency in CE II in
order to enter the clinic.
8.
Student must purchase required
medical equipment, ordered in this
course, prior to entry into the clinic.
NUTRITION CLINIC ENTRY
Course Description:
This course prepares students for clinic
by reviewing clinic requirements,
protocols, and standards of care and
practice. Students will become familiar
with clinic paperwork. Expectations and
roles are clearly defined. The course
includes a series of presentations by
clinic faculty and staff. Students will
spend time observing nutrition clinic
18
Student Clinician Handbook, 2003-2004
shifts. Students take a clinic entry exam
at the end of the course and will need to
pass the exam before being eligible to
enter clinic.
6. Hepatitis B immunization or
waiver
7. Washington State Patrol
background check
MSN
a. Prerequisites: BC5128, TR5320
(co-requisite)
b. Credits: 1.0
c. Required Text: Student Clinician
Handbook
Credits/Shifts:
Credits:
8 total (1 credit = 22
hours; 2.0 credits per
shift)
Shifts:
four 2-credit shifts plus
0.5 credits (12 hours)
interim clinic
Hours:
188 total hours
BSN DPD
a. Prerequisites: BC4128, RD4320
(co-requisites)
b. Credits: 1.0
c. Required Text: Student Clinician
Handbook
AOM Clinic Primary Internship
Internship prerequisites:
1. Must have successfully
completed 4 observation shifts
2. Must be matriculated in the MSA
or MSAOM degree program and
have successfully completed the
first 5 quarters of AOM and basic
science curriculum and be in
good academic standing.
3. Must have a current CPR for
healthcare providers card, must
have passed the CCAOM Clean
Needle Technique exam and
passed the AOM Clinic Entry
exam with a minimum score of
70%.
4. TB screening
5. Hepatitis B immunization or
waiver
6. Washington State Patrol
background check
SUMMARIES OF CLINIC
REQUIREMENTS
AOM SUMMARY OF CLINIC
REQUIREMENTS (MSA AND
MSAOM)
Following is a summary of the
requirements students will need to meet
in order to graduate and be eligible for
NCCAOM diplomat status and
Washington State acupuncture licensure
(LAc):
AOM Clinic Observation Internship
Clinic prerequisites:
1. Successful completion of Clinic
Entry I.
2. AOM enrollment and good
academic standing with passage
of all required first quarter
classes.
3. Current CPR for Health Care
Providers card
4. Completion of Observation
Check-off Form
5. TB screening
Acupuncture Intern B and
Acupuncture Intern A:
Acupuncture Intern B (AIB): after
successfully passing the Clinic Intern
Entry Exam, the student will enter
internship as an Acupuncture Intern B.
During the first 100 patient treatments
19
Student Clinician Handbook, 2003-2004
supervisors will closely observe and
guide the clinician. When the AIB nears
his or her 100th treatment an evaluation
is required with the AOM Clinic
Program Coordinator.
and a 2-credit clinic project for
MSAOM.
Credits/Hours:
1. MSA: 38 credits/836 hours (1 cr.
= 22 hours)
2. MSAOM: 56 credits/1232 hours
(1 cr. = 22 hours)
1. Acupuncture Intern A (AIA):
After the AIB successfully
completes the first 100
treatments and had been
evaluated, and given
recommendation to continue,
they may proceed through
internship with more autonomy
but continued consultation and
assistance of the supervisors. A
minimum total of 300 additional
patient treatments are expected of
students who have achieved
Acupuncture Intern A status (a
total of 400 patient treatments is
required by AOM Interns).
Patient Contacts:
A total of 400 patient
treatments/contacts is required by
AOM interns.
1. Intern AIB must perform 20 first
patient interactions and 80
subsequent patient interactions
over a minimum of 3 academic
quarters and 5 clinic shifts.
2. Intern AIA must perform 300
additional patient interactions.
AOM Shifts
Following is a breakdown of the
requirements for shifts, hours, and
patient contacts:
1. Students must register for clinic
shifts during every quarter in
which they are clinic eligible and
enrolled at Bastyr University.
Exceptions to this quarterly clinic
attendance requirement are
reserved for extenuating
circumstances. Failure to
register for clinic shifts will
delay a student’s graduation date.
Students are required to follow
the timeline laid out in the
Catalog.
Shifts:
1. MSA: Fourteen 2-credit shifts
plus 1-credit (24 hours) interim
clinic for MSA.
2. MSAOM: Fourteen 2-credit
shifts plus 1-credit (24 hours)
interim clinic and 8 2-credit
Chinese Herbal Medicine shifts
plus a 2-credit dispensary shift
20
Student Clinician Handbook, 2003-2004
Figure 2 AOM Clinical Program Schedules
AOM Observers and Primary Interns are expected to follow the following clinical
education schedule:
Term
1
2
3
4
5
6
7
8
9
10
Year/Quarter
Year 1 – Fall
Winter
Spring
Year 2 – Fall
Winter
Spring
Summer
Year 3 – Fall
Winter
Spring
Shifts
Observation 1
Observation 2
Observation 3
Observation 4
Primary 1-2
Primary 3-6
Primary 7-9
Primary 10-12
Primary 13-14
Chinese Herbal Medicine certificate Observers and Primary Interns are expected to
complete the following Chinese Herbal Medicine shifts during the MSAOM program:
Term
1
2
3
4
5
6
7
8
9
10
11
12
Year/Quarter
Year 1 – Fall
Winter
Spring
Year 2 – Fall
Winter
Spring
Summer
Year 3 – Fall
Winter
Spring
Summer
Year 4 – Fall
2. China Externship Option:
Approved sites only. Up to 8
credits of internship may be
registered for in the China
Externship program. The AOM
Program Chair will review
patient contacts. China
Externship requires application
and good academic standing.
Shifts
1
2
3-4
5-6
7-8
Third year is the preferred time
for the China Externship.
3. External Clinic Shift (formerly
Advanced Preceptorship): Up to
2 credits of external clinic shift
may be available to students with
strong academic standing. As
with observation, external clinic
21
Student Clinician Handbook, 2003-2004
shift hours are 44 per 2 credits.
For more information contact
Clinic registration staff.
Coordinator before registering
for an off-site clinic shift.
Specialty Clinics
At present the BCNH runs the following
specialty clinics with AOM program
involvement:
1. Immune Wellness Clinic: A
clinic option focusing on HIV
and AIDS. Students are asked to
commit to 3 consecutive
quarters. There is an emphasis
on integrated therapy and
education in the field of AIDS.
2. Herb Clinics: Third year
MSAOM or Certificate of
Chinese Herbal Medicine
students only are allowed into the
Herb Clinic shifts.
3. AOM/ND Integrated Shift: This
shift combines AOM clinic with
ND clinic under the supervision
of a licensed ND, LAc for
students entered in both AOM
and ND programs. Credit will be
given for AOM hours and
contacts only.
4. Clinic Sites: The AOM Clinical
program currently offers several
clinical training sites outside of
the Bastyr Center for Natural
Health. These sites include
Rainier Park Medical Clinic,
High Point Medical Clinic, and
Carolyn Downs Family Medical
Center. Observation students
must be in their 3rd observation
shift before registering for an offsite clinic. Interns in good
academic standing are eligible
for registering for off-site clinic
opportunities. It is strongly
preferable that a student be in at
least their 5th intern shift before
registering for an off-site clinic.
Students with less experience as
either an observer or intern must
have the written pre-approval of
the supervising clinical faculty
and the AOM Clinic Program
22
Student Clinician Handbook, 2003-2004
MSAOM and CCHM Herbal Clinic
Requirements
and interim clinic; all shifts must be
passed with a grade of AC)
Prerequisites
1. CH 6803 CHM Clinic 1
(observation) may be taken
concurrently with Materia
Medica 1 – 3.
2. Must have completed CH 5411,
6412, 6413 (Materia Medica 1 3) prior to starting as an Intern.
Total number of hours: 1,224.5
(includes patient care, preceptorship,
interim clinic, clinic grand rounds)
Total number of patient contacts: 350
(includes patients seen in the clinic:
general patient care, homeopathy,
counseling and physical medicine, sub
and extra hours, interim clinic, float
rooms). This does not include patient
contacts seen in preceptorships.
Herbal Clinic Intern:
1. Credits: 16 credits over no less
than one academic year
2. Shifts: Eight 2-credit shifts
including interim coverage
3. Hours: 352
• All Clinical Competencies must be
signed off by supervising clinical
faculty.
• A standardized patient clinic promotion
exam may be a requirement for
promotion from secondary/observing
clinician to primary clinician for all
students.
Herbal Dispensary
This two-credit course is designed to
teach, in a practical hands-on method,
the art and science of preparing and
dispensing Chinese herbs. Students may
register for dispensary any time after
their Herbal Medicine Curriculum has
begun.
• A standardized patient clinic exit
examination may be a requirement for
graduation for students entering the
clinic during the current year. This
exam will be offered during the winter
of a student’s final year in clinic.
Students will be given the opportunity to
remediate this exam if necessary.
CHM Clinical Project
Students are required to do a clinical
project related to Chinese Herbal
Medicine. (2 credits)
• All clinical hours must be completed,
all patient contact requirements must be
met, and all required paperwork must be
completed and submitted.
ND SUMMARY OF CLINIC
REQUIREMENTS
Following is a summary of the
requirements students will need to meet
in the naturopathic degree program in
order to graduate and be eligible to take
board examinations:
• A student will not receive their degree
until all requirements are met at a level
of achieved competency and the clinical
faculty recommends the student for their
ND degree.
Total number of shifts: 21 clinic shifts
(plus clinic lab diagnosis, preceptorship,
23
Student Clinician Handbook, 2003-2004
Following is a breakdown of the requirements for shifts, hours and patient contacts:
1. Shift Requirements:
a) Patient care shifts: 21 (17 general patient care [includes minimum of 1 and up to
2 counseling, and may include up to 4 optional homeopathy] and 4 physical
medicine.)
b) Clinic lab diagnosis (Campus) (3Q, 2hr/wk lab): Total credit 3 cr/quarter
including class
c) Preceptorship shifts: 3 (to be done with doctors/health care professionals/clinics
outside Bastyr Center)
d) Interim patient care (44 hours)
2.
Credits:
a)
b)
c)
d)
e)
Clinic entry I and II
Patient care shifts:
Clinical lab diagnosis:
Preceptor shifts:
Interim clinic:
2 credits
42 credits
9 credits including class
3 credits
2 credits
3. Hours:
a) Clinic Entry I and II –
25.5 hr. (2 credits)
b) Patient care hours
924
c) Lab rotation
99
e) Preceptorship hours:
132
f) Interim clinic hours:
44
[Interim clinic is registered as interim patient care]
Total Hours
1224.5
. Patient Contacts (ND):
a. Students need a minimum of 350
patient contacts in the 21 patient
care shifts, interim clinic, sub
and extra hours; a minimum of
175 must be primary contacts.
This averages to 16.7 patients for each of
the 21 shifts including patients seen on
interim clinic, and during sub and extra
hours.
b. Student may include preceptor
contacts in their total primary
patient contacts only with the
approval of their clinic advisor.
Each contact is evaluated by the
advisor regarding the degree of
c.
hands-on case management by
the students in order to determine
sufficiency for primary patient
contact credit.
Students in their 1st clinic year
(Summer through Spring) cannot
be registered for more than 6
shifts for the year, and not less
than 1 shift per quarter.
ND Shifts
1. It is required that each student be
enrolled in at least one patient care shift
every quarter that they are clinic
eligible. There is a maximum of 6 shifts
24
Student Clinician Handbook, 2003-2004
allowed during the 1st year in the clinic.
Exceptions to this quarterly clinic
attendance requirement are reserved for
extenuating circumstances and must be
approved by the Clinic Medical Director.
Failure to register for clinic shifts will
likely delay a student’s graduation date.
Students are required to follow the
timeline laid out in the Catalog.
Figure 3 ND Clinical Program Schedules
For 4-year track and 5-year track option A:
Year/Quarter
Year 3 of 4 or Year 4 of 5:
Summer
Fall
Winter
Spring
Number of Clinic Shifts
1-2
1-2
1-2
1-2 (note: no more than 6
shifts total in the first
year of any ND track)
Year 4 of 4 or Year 5 of 5:
Summer
Fall
Winter
Spring
3-4
3-4
3-4
3-4
For 5-year track option B:
Year/Quarter
Year 3 of 5:
Summer
Fall
Winter
Spring
Number of Clinic Shifts
0
1-2
1-2
1-2 (note: no more than 6
shifts total in the first
year of any ND track)
Year 4 of 5:
Summer
Fall
Winter
Spring
Year 5 of 5:
Summer
Fall
Winter
Spring
1-2
1-2
1-2
1-2
3-4
2-3
2-3
2-3
25
Student Clinician Handbook, 2003-2004
2. External Site clinics, currently
consisting of: Bastyr University
Campus, Covenant Shores, 45th St.
Homeless Youth Clinic, Northwest
Center for Optimal Health, Women’s
Wellness Center, One Sky Medicine,
and Mary’s Place, may fulfill a student’s
clinic requirements. These sites may
change from time to time as the external
site program is expanded or modified.
b. Students will be scheduled for
Interim Clinic according to the
preceding quarter shift schedule,
and are responsible for attending
the same weekly shifts that they
were scheduled for during the
preceding quarter. Students must
complete their required interim
hours over several interim
periods. Unapproved absences
during interim will count as
unexcused absences and will
result in a requirement to make
up the 4 hours missed plus an
additional 12 hours of clinic
shifts for each missed shift.
c. Students will be automatically
registered for interim Spring
Quarter of their graduating year.
An AC for interim depends upon
successful completion of all
required interim shifts.
3. A student may request an advanced
preceptorship in place of a regularly
scheduled patient care shift if they have
successfully completed at least eleven
patient care shifts, have completed all of
their required preceptorships and are in
good academic standing. The student
must submit a written request describing
the external site to the Clinic Medical
Director. This letter must be
accompanied by a letter from the
supervisor/physician on the external site
describing the nature of their practice
and the nature of the students proposed
experience. Please refer to the ‘AOM
and ND Advanced Preceptorships’
section of this handbook (page 34) for
the complete description of these
requirements.
6. Up to 4 shifts can be taken in
homeopathy. Additional shifts must be
approved by ND clinical faculty and the
homeopathy chair (see additional shift
request, #9 below).
a. Prerequisites must be completed
prior to entering a homeopathy
shift. (Homeopathy classes 1-3
are required prerequisites;
Homeopathy 4 is highly
recommended.)
b. Clinic Department
Coordinator/supervising clinical
faculty approval must be granted
in order to be on a specialty shift
related to that department.
c. All students who are registered
for a homeopathy shift are
required to be registered in
Homeopathy Grand Rounds.
Other students may enroll in
Grand Rounds with approval of
the instructor.
4. Required for clinic laboratory
diagnosis:
a. 1 lab rotation (3 quarters of lab
portion of the Clinical Lab
Diagnosis course)
b. 66 hours (99 hours, including
class)
c. This lab rotation occurs on
campus
5. Interim clinic requirements:
a. All 44 hours must be done in
Patient Care or Physical
Medicine.
26
Student Clinician Handbook, 2003-2004
counseling 1 - 2, physical
medicine 4 - 6.
7. Students must take 2 physical
medicine shifts each year for 2 clinical
years, for a total of 4 shifts. (See
additional shift request, #9 below.)
10. Students are strongly encouraged to
take at least one external clinic shift
during their clinical training. There is no
maximum limit; however, clinical
faculty reserve the right to restrict the
number of external shifts a student
participates in.
a. Only 1 physical medicine shift
should be taken in any one
quarter.
b. Prerequisites must be met before
taking physical medicine shifts.
8. Students must be registered for a
minimum of 1 shift, and a maximum
of 4 shifts, per quarter in any quarter
in which they are clinic eligible and
enrolled at Bastyr University. (Note:
Students in their first year of clinic
are allowed to take only 6 shifts in
that year.) At least one of the
assigned quarterly clinic shifts must
be a patient care shift for each
student. Students may not be
registered for more than 2 shifts on
any given day. Students wishing to
take more than 4 shifts per quarter
must submit a written request to the
Clinic Medical Director prior to
registration. Failure to follow
recommended shift registration will
delay graduation date.
ND Counseling Shift Guidelines
1. Absences: All absences must be
excused. All hours missed must
be made up in counseling. This
can be done through 1) interim
clinic, or 2) if off-shift
counseling privileges are given
by the counseling supervisor (this
is done by seeing a patient in a
float room, if available, or during
the counseling shift). A note
signed by the counseling shift
supervisor signifying approval
for off-shift counseling is
required to be in the student’s file
at the Registrar’s Office.
2. Substitutes: Substitutes are not
used when a clinician is absent
from a counseling shift.
Absence/sub paperwork
procedure must still be followed,
with the exception of leaving the
“name of substitute” line blank.
9. Students wishing to take additional
specialty shifts beyond the maximum
number (homeopathy, counseling, or
physical medicine) must submit
requests to the Clinic Medical
Director. Written requests must be
submitted to the Clinic Medical
Director at least one month in
advance of registration for the
requested shift.
3. Off-Shift Counseling: Students
who have completed a
counseling shift may be given
off-shift counseling privileges in
order to continue counseling
patients they have been working
with on the counseling shift.
This would include an allowance
a. Minimum and maximum amount
of shifts: homeopathy 0 - 4,
27
Student Clinician Handbook, 2003-2004
to see patients (one per patient
care shift) outside of the
counseling shift. Each patient
must be assessed by meeting
with the counseling supervisor
prior to their first session (or
during the first session).
Students must meet with the
counseling supervisor between
each patient visit for supervision.
A note signed by the counseling
shift supervisor signifying
approval for off-shift counseling
is required to be in the student’s
file at the Registrar’s Office.
7. Interaction Between Clinic and
Counseling Center
a. Counseling Center Student
Staff Counselors will not
provide counseling services
in both locations (clinic
services at the Center and
counseling services in the
Campus Wellness Center),
but must only provide
counseling at the Campus
Wellness Center.
b. This policy is an attempt to
safeguard both the student
receiving services and the
student clinician providing
services from a potential
conflict of interest, i.e.
harassment, that could result
from exposure in a dual role
setting.
4. Interim Shifts: Interim
counseling shifts are available to
those clinicians currently on a
counseling shift, to those needing
to make up any previous
counseling absences, or if the
need arises, by approval of the
counseling supervisor. Only
those who already have taken a
counseling shift may sign up for
an interim counseling shift.
c. Only under special
circumstances will an
exception be granted. The
CEI student must submit the
request in writing. The
student’s staff counselor must
also submit a statement in
writing. The requests will be
reviewed by the Counseling
Center Director, the Clinic
Medical Director, and all
appropriate clinic shift
supervisor (i.e. AOM,
Counseling, ND, Nutrition,
etc.) All involved reviewers
must approve the request.
5. Second Shift Requests: Students
wishing to take a second shift
may do so depending upon the
availability of openings. Sign up
is through the Registrar’s office.
See Clinic Policy regarding
taking more than the required
amount of patient care specialty
shifts. No more than 2
counseling shifts may be taken.
6. Counseling Shift Assignments:
Students will be randomly
assigned a counseling shift,
during their first clinical year,
and must take the shift during the
quarter assigned.
Due to ethical considerations, student
clinicians may not “self-refer” student
clients to their own private practice,
outside the Bastyr Center for Natural
Health.
28
NUTRITION SUMMARY OF
CLINIC REQUIREMENTS
required paperwork must be completed
and submitted.
Following is a summary of the
requirements students will need to meet
in order to graduate in the nutrition
counseling track. Nutritional counseling
track students complete 3 quarters of
clinic practicum. This is defined as
follows:
7. Nutrition Exit Exam. Students must
pass the exit exam which is two parts:
1. Total number of shifts: 1 shift for
BS-DPD students and 3 shifts for
MS clinical/counseling track
students; all shifts must be passed
with a grade of AC.
2. Interim clinic hours: 8 hours are
required for MS Nutrition
clinical/counseling track students.
These hours must be completed in
order to graduate. All interim hours
must be signed by the clinic
supervisor and once completed,
turned into the clinic registration
staff.
3. Total number of hours: 44 shift
hours per quarter.
4. Total number of patient contacts:
MS clinical/counseling track
students must see 10 patients as a
primary and 15 patients as a
secondary by the end of clinical
practicum 3. There are no
requirements for BS-DPD students.
5. All Clinical Competencies must be
signed off by supervising faculty.
6. All Clinical Hours must be
completed, all patient contact
requirements must be met, and all
a. Video Taping – Student
clinicians in their third quarter
must have a FOC or FOC2
appointment videotaped and
graded by the shift supervisor.
The videotaped evaluation will
be graded as pass/fail. If the shift
supervisor notes deficiencies and
gives a failure grade, the
videotape will be independently
evaluated by the Nutrition Clinic
Coordinator or other designated
nutrition faculty for a second
opinion of the deficiencies. If
disagreement regarding the grade
still exists after the second
evaluation, the Nutrition
Department Chair will evaluate
the videotape. If a failure grade
is received, the student will have
to enroll in an additional entire
quarter of Clinic Practicum and
repeat the videotaped patient
appointment. The student will
receive a notification letter
approximately two weeks after
the videotaped appointment of
the grade result.
b. Written Exam – An open book
written examination will take
place once a year at the end of
Spring quarter. The examination
will be three hours and will
consist of three case studies.
Students will be required to write
a SOAP note for three case
studies. Subjective information
and parts of the Objective
information will be provided.
Student Clinician Handbook, 2003-2004
Students will have to complete
the remaining Objective
information, the Assessment, and
Plan portions of the SOAP note.
Students are responsible for all
information contained in the
clinic protocols standards for
SOAP noting (see SOAP
template). The examination will
be graded as pass/fail. The
Nutrition Clinic Department
Coordinator will grade the
examinations. All three case
studies must receive pass grades.
If one or more of the case studies
do not receive a pass grade, an
additional case study, or studies,
must be completed during final
exams week the following
quarter. If the case study, or
studies, are failed for a second
time, additional course work will
be required at the discretion of
the Nutrition Faculty. The
student will receive a notification
letter approximately two weeks
after the written examination date
of the grade result.
provide on-going care for our patients
during academic breaks.
You are RESPONSIBLE FOR SHIFT
COVERAGE and are required to find
substitutes for your interim shifts if you
will not be able to attend.
1. AOM Interim clinic Requirements
for graduation:
Requirements for observation:
a)
credits: 0.5
b)
hours: 12
Note: To be completed over the
course of all weeks of Interim
clinic.
Requirements for Internship:
a)
credits: 1
b)
hours: 24
Note: To be completed over the
course of all weeks of Interim
clinic.
Note: Students are automatically
registered for Interim Clinic credits
(1.5).
2. ND Interim clinic Requirements for
graduation:
a. Credits: 2
b. Hours: 44
8. A student will not receive their
degree until all requirements are met and
the clinic faculty recommends the
student for their degree.
To be completed over the course of all
weeks of Interim clinic. The last
opportunity for interim clinic is at the
end of Winter Quarter prior to June
graduation.
INTERIM CLINIC
Interim Clinic is defined as days during
which the clinic operates, but academics
does not conduct regular classes.
Interim Clinic occurs during distinct
time blocks, separate from regular clinic
shifts, but staffed by the same clinic
teams (interns and supervisors) as the
prior quarter. Interim Clinic occurs at
the end of each quarter, allowing us to
Note: Students are automatically
registered for Interim Clinic credits (2)
during the Spring Quarter of their fourth
year. This will appear on registration
form as interim patient care.
3. Nutrition Interim Clinic
Requirements for graduation:
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Student Clinician Handbook, 2003-2004
Nutrition students are required to
complete 8 hours for Interim.
Additional hours completed during
interim may be used to make up
missed clinic shifts for the
corresponding quarter.
Form, and patient contacts on the
Summary of Patient Contacts Form.
6. Students will be responsible for
interim clinic shifts during the same
days/times they were scheduled for
shifts during the preceding quarter.
Absence requests must be approved by
the student’s supervisor and submitted
two weeks prior to the start of the
interim period. Additional shifts may be
requested and taken during the interim
period, if desired and available.
Interim clinic is currently offered during
the following times:
Winter break, between Fall and Winter
Quarter *(2-3 weeks)
Spring break, between Winter and
Spring Quarter* (1 week)
4. Patients seen during interim clinic on
patient care shifts are counted
towards the total
number of patient contacts. Students
should use the Patient Summary Form to
keep a record of the patient contacts. In
the ND program, all 44 hours must be in
Patient Care/Physical Medicine.
7. At the end of each interim clinic
period, all paper work must be turned in
to the clinic registration staff to receive
credit.
8. Any unexcused absence during
Interim Clinic will result in a
requirement to make up the 4 hours
missed plus an additional 12 hours of
clinic shifts for each missed shift. These
hours are in addition to the required
interim hours for each program.
5. Additional interim hours [above the
44 hours (ND) or 36 hours (AOM) or 8
hours (Nutrition)] can be used to make
up shift hour deficits from the current or
past quarters. These hours should be
tracked on the Substitute and Extra
9. ND/AOM dual-track students need to
complete 44 hours of ND interim clinic
and 36 hours of AOM interim clinic.
PLEASE NOTE: Due to calendar changes, Interim weeks are subject to change without
notice. Please be advised of this possibility.
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Student Clinician Handbook, 2003-2004
Your Student Preceptorship Plan must
be turned in prior to embarking on a
preceptorship.
PRECEPTORSHIPS
AOM PRECEPTORSHIP
PROGRAM
Preceptorships provide students
observational experience with
established practitioners outside of the
Bastyr Center. AOM preceptorships are
not required, however students may opt
for 44 hours of preceptoring as a
substitute for Clinic Observation Shift
IV. Clinical shifts I and II must be
completed prior to beginning a
preceptorship for Clinic Shift IV.
All additional forms must be completed
in full, signed, and turned in to the
Placement Coordinator to receive credit.
(No other forms/format accepted.)
Please submit within a month of
preceptorship completion for credit.
1. Preceptorship Clinical Time Sheet
2. Summary of Patient Contact Hours
(must be documented for credit)
3. Preceptor’s Student Evaluation
4. Student’s Evaluation of Preceptor
5. Student’s Self-Evaluation
Note: Please copy all completed forms
(for your personal files) prior to turning
original lavender paperwork in to the
Placement Coordinator.
All completed AOM Preceptorship
documentation will be processed in the
Placement Coordinator’s office and
forwarded to the Campus registration
staff for transcription purposes.
Registration for AOM preceptorship
credits is processed, as all other
registration, through the Campus ClinicRegistrar.
Establishing Preceptorships:
All preceptors must be PRE-approved,
prior to beginning preceptorship. As
AOM approved preceptors are very
limited, you must contact the Placement
Coordinator’s office for current
opportunities. You are always welcome
to recruit a new AOM preceptor but
must have approval prior to working
with anyone.
For Advanced Preceptorships, contact
the AOM Clinic Department
coordinator.
AOM Preceptor Application Forms, for
new preceptors, are available in your
Placement Coordinator’s office, located
on the third floor of the Bastyr Center
for Natural Health.
To set up an appointment or to obtain
additional information regarding AOM
preceptorship sites, preceptor
applications, student packets, etc.,
contact:
AOM Requirements When Opting
For Preceptorship
If opting to replace a Clinic Observation
Shift with a Preceptorship, you are
required to log 44 hours of observation
time, equal to one credit, with your
approved preceptor.
Placement Coordinator
Office of Graduate and
Community Medicine
Bastyr Center for Natural Health
206.834.4100
32
Student Clinician Handbook, 2003-2004
file until remainder of packet is
processed. You do not need
confirmation of approval when turning
the plan in — you will, however, be
notified if additional data is required.
NATUROPATHIC
PRECEPTORSHIP PROGRAM
Preceptorships are for the purpose of
providing observational, hands-on, or
limited hands-on experience with
established practitioners outside of the
Bastyr Center for Natural Health. You
have the option of working with preapproved preceptors in either private
practice or other community settings.
ND Preceptorship Graduation
Requirements/Options:
You must have a total of 132 hours (3
credits) of documented preceptorship
experience.
Note: Please copy all completed
documentation (for your personal files)
prior to submitting the original (blue)
preceptorship forms to your Placement
Coordinator. (Originals may be dropped
by the Placement Coordinator’s office at
the Center or mailed from Campus in
“Interdepartment Delivery” envelopes.)
1. At least 88 preceptorship hours
must be with an ND.
2. You may have up to 44 hours
credited with a non-ND.
3. At least three different sites (i.e.,
locations) are required
4. A minimum of 20 hours is
required at any given site.
Establishing Preceptorships:
If enrolled in 2000 or later you must
complete 22 preceptorship hours prior to
beginning clinic shifts. Pre-clinic
preceptorship credit hours are limited to
44.
All preceptors must be PRE-approved,
prior to beginning preceptorships, to
insure credit hours and Bastyr liability
coverage. Preceptor Site Information is
available on the Bastyr Intranet in the
Center and Campus libraries; access
through Internet Explorer at
http://precept/. Data includes preceptor
names, locations, phone numbers,
student requirements, and other relevant
information. You may contact
preceptors in database (unless otherwise
noted) or recruit a new practitioner. ND
Preceptor Application Forms for new
preceptors can be obtained from your
Placement Coordinator at the Center or
the Campus Clinic-Registrar’s Office. It
is helpful when new applications and
student plans are submitted together.
All attached forms must be completed in
full, signed, and turned in to your
Placement Coordinator to receive credit.
(No other forms/format accepted!)
Please submit within a month of
preceptorship completion. Submitting
preceptor’s evaluation with your
paperwork speeds process.
a. Preceptorship Clinical Time
Sheet
b. Summary of Patient Contact
Hours (do not leave blank —
data must be filled in for credit.)
c. Preceptor’s Evaluation of
Student
d. Student’s Evaluation of
Preceptor
e. Student’s Self-Evaluation
The ND Student Preceptorship Plan
Form (found in blue ND preceptorship
packet)—must be turned in prior to
embarking on a preceptorship. This
provides valuable information for your
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Student Clinician Handbook, 2003-2004
All completed preceptorship forms and
documentation will be processed in your
Placement Coordinator’s office. A
printout of your documented hours and
patient contacts will be placed in your
student box — please retain for future
reference. Original copies of hours and
patient contacts will be forwarded to the
Campus Clinic-Registrar for
transcription of your credit hours.
competency in each. (This does not
include Physical Medicine.)
c. Student must be in good academic
standing.
2. An AOM student may only apply for
advanced preceptorship after the
following requirements are completed:
a. Observation Requirements must
be complete.
b. Eight intern shifts must be
completed with a grade of achieved
competency in each.
c. Student is in good academic
standing.
Registration for ND Preceptorship
Credits is processed the same as all other
registration, through the Campus ClinicRegistrar’s Office. Please contact that
office for all preceptorship registration
or related credit queries.
3. All student requests for advanced
preceptorships must be typewritten.
AOM students must submit their request
to the AOM Clinic Department
Coordinator. ND students must submit
their request to the ND Clinic
Department Coordinator. The request
must include:
For Advanced Preceptorships contact the
Clinic Medical Director.
To set up an appointment or to obtain
additional information regarding
preceptorship sites, preceptor
applications, student packets, etc.,
contact:
a. A statement as to the reason for
the request, number of preceptorship
hours already completed and number
of patient care or intern shifts
completed.
b. The name of the external clinic
site and supervising clinician.
c. The number of hours to be
completed (44 hours is equivalent to
1 shift, 88 hours are the maximum
allowable).
d. Each advanced preceptorship
must be requested independently.
e . A letter from the supervising
physician or acupuncturist of the
advanced preceptorship must also be
submitted with the request. This
letter must outline the student’s
activity, a description of the nature
and extent of the student’s hands-on-
Placement Coordinator
Office of Graduate and Community
Medicine
Bastyr Center for Natural Health
206.834.4100
AOM AND ND ADVANCED
PRECEPTORSHIPS
1. An ND student may only apply for an
advanced preceptorship after the
following are completed:
a. All 132 hours (3 shifts) of
preceptorship must be completed,
submitted and passing grade
received.
b. Eleven patient care shifts must be
completed with a grade of achieved
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Student Clinician Handbook, 2003-2004
experience, an estimate of the
number of patients, a description of
the active case management on the
part of the student, and a description
of the nature of the active
supervision by the preceptor. All of
the elements are required for
advanced preceptorship approval. If
the advanced preceptorship
supervisor is not already an approved
preceptor site, please contact the
Preceptor Coordinator for
application materials.
by the supervisor. The number of
patient contacts that are counted will
depend on the type of experience you
have. This will be reviewed and
determined by the Clinic Department
Coordinator.
8. After completing the advanced
preceptorship, the completed paperwork
should be turned in to the clinic
registration staff for evaluation and
determination of the number of patient
contacts. The clinic registration staff will
then forward the paper work to the
Clinic Department Coordinator for a
final grade to be assigned. This grade
will be sent back to the registrar. The
student must also give notice of
completion of the experience to the
Preceptor Coordinator so that a thankyou note can be sent to the advanced
preceptor supervisor.
4. The respective Clinic Department
Coordinator will present the student’s
request to the clinic faculty for
consideration of approval through
voicemail or at the next scheduled
clinical faculty meeting. The clinic
faculty will determine the student’s
eligibility for the advanced
preceptorship.
AOM PROGRAM CHINA
EXTERNSHIP
5. If the request is approved, an
approval letter will be sent by the Clinic
Department Coordinator to the Clinic
registration staff. The student will be
notified in writing of approval and
advised of required paper work. The
student will then meet with the Clinic
Registration staff to fill out the required
paperwork.
Students may study acupuncture and/or
Chinese herbal medicine in China.
Bastyr currently has two sites in China
where students can study and receive
credit for clinic shifts. These are
Shanghai University of TCM and
Chengdu University of TCM.
6. The total number of advanced
preceptorship shifts a student can apply
for is 2 (88 hrs). All external clinic shifts
must be registered and paid for as a
general patient care shift (2 credits per
shift/per 44 hours).
A. STRUCTURE
The structure for studying in China is as
follows:
1. All students going to China are
required to be there for 4 weeks.
Similar to preceptorship, credits
are figured as 1 clinic shift (2
credits) per 44 hours. One full
week of China Clinics averages
about 44 hours.
7. Students must keep careful records of
the patient contacts during an external
clinic shift. The Summary of Patient
Contacts Form must be used for this
purpose, as well as a time sheet signed
35
Student Clinician Handbook, 2003-2004
2. For those students who are in the
MSA program and wish to study
acupuncture in China, you will
need to apply to Chengdu
University. The last MSA
program classes end in the spring
quarter. Chengdu externship
study is offered during the
following summer quarter.
C. CREDIT/PATIENT CONTACT
DOCUMENTATION
SPECIFICIATIONS
1. Only patient contacts that involve
diagnosis and treatment of
sufficient length under proper
supervision may be considered for
credit.
2. Students must keep documentation
on all contacts to be considered for
credit. All clinic hours must be
kept and signed off with patient
contacts by the supervising doctor.
Documentation of all contacts
considered for credit must be
presented to the AOM department
chair upon return for review and
approval.
3. An evaluation form will be sent to
each site for completion by each
supervisor. Students must
complete an evaluation form for
each major supervisor at each
China site.
3. For those students who are in the
MSAOM program and wish to
study herbal medicine in China,
you will need to apply to
Shanghai University. The last
MSAOM classes are scheduled
to end in the summer quarter.
Shanghai internship study is
offered during the following fall
quarter. Students may choose to
study in any of the following
departments: Traumatology,
Internal medicine, Gynecology,
Tui na.
4. Studies in qi gong or tui na may
be available if so requested.
4. Upon completion of their China
externship, each student will be
required to complete a typed paper
about their externship. The format
and requirements for this paper
will be given prior to the
beginning of the externship.
B. REQUIREMENTS
1. You must be in good academic
standing with a GPA of 3.0 or
higher.
2. Third year status with a minimum
of 8 intern shifts of experience.
3. All Bastyr university fees paid to
date.
4. Approval by AOM department
chair.
5. Completion of the AOM Program
China Externship Application
form (see page 214).
6. One page typed paper on why you
wish to study in China.
For more information, contact the China
Trip Coordinator (Center, 206-8344100).
STUDENT ACADEMIC
ADVISING
AOM AND ND
1. The following is required for student
advising with a clinical faculty advisor:
36
Student Clinician Handbook, 2003-2004
a. Each student clinician is required
to meet with her/his clinical
faculty advisor 1 time/year for
each year they are enrolled in the
clinic. Students are encouraged
to meet with their advisor as
often as needed.
b. Each student clinician will be
assigned to a clinical faculty
advisor. If for any reason that
assignment needs to be changed,
please see the main campus
registrar’s office.
c. AOM students may still be
assigned a campus advisor during
their 2nd year.
d. There is a one-page advising
form that the student should fill
out and bring to the advising
session. The advisor will write
her/his comments on the form,
sign and date it. The student is
responsible for providing a copy
to the clinic registration staff.
e. It is the student’s responsibility
to contact her/his advisor and
make an appointment.
f. The advising sessions are a time
for students to share any
concerns, problems, complaints,
suggestions or issues that are
important to her/him. Advisors
are to review a student’s
academic program and keep them
on track with their course/clinical
requirements.
g. If a student fails to meet her/his
requirement of 1 advising
session/year, prohibition of
enrollment in following quarter
shifts or, if graduating, failure to
graduate until the advising
sessions are completed will
occur. (A clinic year is from the
beginning of Summer Quarter to
the end of Spring Quarter, so a
determination for advising will
be made for the year at the end of
Spring Quarter.)
2. At least 1 advising session is required
with the Clinic Registration staff before
graduation.
a. It is recommended that students
meet with the Clinic Registration
staff near the beginning of their
clinical experience in order to
clarify and understand the clinic
education requirements, and how
their progress is tracked each
quarter.
b. Each quarter the Clinic
Registration office will provide
to each student a summary of
her/his completed requirements.
c. Additional advising sessions are
recommended in order to stay
current with completed and
remaining outstanding
requirements.
d. It is required for graduating
students to meet with the Clinic
registration staff in their last
quarter in order to be on-track to
graduate.
3. The acupuncture Intern B (AIB) must
meet with the AOM Clinic Program
Coordinator or faculty designee, upon
completion of all Clinical Competency
Two Objectives to determine
advancement to Acupuncture Intern A
(AIA). These competencies include the
AIB performing a minimum of 20 first
patient interactions (FPI) and 80 return
office calls (ROC) over a minimum of 3
academic quarters and 5 clinic shifts.
NUTRITION
The Nutrition Clinic Department
Coordinator is responsible for advising
37
Student Clinician Handbook, 2003-2004
all clinic nutrition students regarding
student progress. Students should see
their assigned nutrition academic advisor
for issues related to progress in
coursework, graduation, careers, etc.
5) After viewing the faculty
schedule, all students will submit
to the clinic registration staff, by
the stated deadline, their requests
for the supervisors and times of
their assigned shifts for the
upcoming quarter. These
requests must be during the days
assigned to the students based
upon their assigned academic
track and course schedule.
STUDENT REGISTRATION
FOR CLINIC SHIFTS
GENERAL REGISTRATION
INFORMATION FOR ALL
PROGRAMS
6) The clinic registration staff will
attempt to meet the student’s
requests when scheduling each
student their required shifts;
however, this is not guaranteed.
1) The clinic registration staff
coordinates registration for clinic
shifts.
2) Registration for each quarter will
take place approximately 9 to 10
weeks prior to the start of the
following quarter. This timing
was chosen so as to avoid
midterms and still allow enough
time for patient scheduling for
the subsequent quarters.
7) Once the schedule is completed
by the clinic registration staff and
approved by the clinic medical
director, it is final and entered
into the patient scheduling books.
8) The clinic medical director may
make changes to the student
clinic schedule at any time.
3) The class schedule for the
following quarter will be
published before clinic
registration occurs. Classroom
and clinic schedules are
coordinated to eliminate
conflicts, as much as possible,
and provide adequate opportunity
for clinicians to stay on track for
graduation. Shift assignment is
performed using information
from each student’s completed
academic registration for
required classes.
9) No student in any program may
do more than two shifts per day.
Shift times may not overlap with
other shifts or courses and an
adequate amount of time must be
maintained for travel between the
clinic, campus, and external site
locations.
10) It is important to note that the
assigned academic track for
students and assigned clinic
shifts for all students are not
amenable to changes necessitated
by other considerations such as
outside employment schedules,
childcare schedules, etc. It is,
therefore incumbent upon every
4) Student clinician pairings are
subject to the final approval of
the Medical Director/Clinic
Department Coordinators.
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Student Clinician Handbook, 2003-2004
student to make whatever
arrangements are necessary in
order to accommodate his or her
assigned academic and clinic
schedules.
circumstances may Intern patient
contacts be shared when only one
Intern was physically performing the
treatment.
2) In general, each AOM student will
be registered for a minimum of two
shifts, and a maximum of four shifts
per quarter.
11) A student may only withdraw
from the clinic if they have a
verifiable emergency. They must
obtain a letter signed by the
Clinic Medical Director
approving this withdrawal.
ADDITIONAL INFORMATION
FOR ND REGISTRATION
12) In order to register for clinic
shifts, students must first register
with the academic registration
staff.
1) The goal is to have a primary and
secondary student clinician in each
room in general patient care,
homeopathy and counseling, and to
have 3-4 primary and 3-4 secondary
student clinicians on each physical
medicine shift. There will be coprimary clinicians in most rooms.
There may be occasions when there
will be three student clinicians
assigned to each patient care room as
a health care team, normally
consisting of one primary and two
secondary clinicians. NOTE: Coprimary designation does not imply
that both clinicians function in the
role of primary for each patient.
Students may never share primary
patient contacts or both act as
primary for the same patients. Coprimaries alternate being in the role
or primary and secondary.
13) For Interim Clinic registration
information, please refer to the
Interim Clinic section of this
handbook.
14) Students may register for clinic
elective shifts including
observation shifts in the other
programs on a space available
basis.
ADDITIONAL INFORMATION
FOR AOM REGISTRATION
1) The goal is to have a primary and
an observation intern in each
treatment room in acupuncture
patient care. There may be
occasions when there will be three
student clinicians assigned to each
acupuncture patient care room as a
health care team, normally consisting
of one primary and two secondary
clinicians. When there are two
interns in one room, both must place
and remove needles during a patient
treatment in order to receive credit
for the patient contact. Under no
2) The available days and times for
clinic shifts will be determined by
the ND student’s academic track.
3) Students will have the opportunity
to add elective shifts, trade
comparable shifts with fellow
clinicians, or drop shifts with a
financial penalty, after the initial
39
Student Clinician Handbook, 2003-2004
shift assignment process is
completed. More information is
distributed by the Registrar’s Office
prior to the shift change period.
scheduling of student clinician
shifts. In the event of a planned
absence, students must fill out an
Absence/Substitute Form –
Student Clinician (see the
Appendix for a copy of this
form), have it signed by the
supervising clinical faculty from
whose shift the student will be
absent, and turn it in to the Clinic
Program Coordinator prior to the
shift, except in case of
emergency. It is the student’s
responsibility to be certain to
include the name of another
student who will cover the shift
in their absence. Please note:
The term shift may refer to either
the quarterly shift, which is a 4hour block (daily shift) that
meets weekly for the 11 weeks of
a quarter, or may refer to the shift
of 4-hours that occurs on a
particular day.
4) In general, each ND student will
be registered for a minimum of two
shifts, and a maximum of four shifts
per quarter. (The only exception is
ND students in their first year at the
clinic; they will have 1-2 shifts per
quarter, with a maximum of 6 total
shifts in that year.) Each ND student
will be registered for at least one
patient care shift per quarter.
ADDITIONAL INFORMATION
FOR NUTRITION REGISTRATION
1) The goal is to have one primary
and one secondary clinicians (one
secondary typically observes from
the observation office) assigned to
each room in nutrition patient care.
The student roles will rotate
throughout the shift.
2) All student clinicians will be
required to attend at least 80% of
each assigned quarterly shift,
including clinic assistant,
observation, intern and patient
care shifts, in order to receive a
grade of achieved competency
for the quarterly shift. Holidays
and emergency closures do not
count against the total quarter’s
attendance, but the missed hours
must still be made up. A student
must attend at least 9 daily shifts
for each quarterly shift in order
to obtain a passing grade for that
shift. A student who does not
attend at least 80% of the
quarterly shift (2 excused
absences) will normally receive a
failure for that quarterly shift,
lose all hours and patient
2) Each Nutrition student must be
registered for at least one nutrition
shift per quarter, but no more than
two shifts per quarter without the
approval of the Nutrition clinic
program coordinator.
CLINIC ATTENDANCE
REQUIREMENTS
All clinical faculty will take attendance,
both at case preview and case review.
1) It is the responsibility of the
Clinic Medical Director, the
program CPC’s, and the
Assistant Patient Services
Manager to make changes in the
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Student Clinician Handbook, 2003-2004
contacts, and the entire quarterly
shift would need to be taken
again. Exceptional
circumstances resulting in a third
absence may be approved at the
discretion of the supervisor.
Four or more absences will result
in an automatic failure for the
shift. Please note that 100% of
your required clinical hours must
be completed before
recommendation for graduation.
4) Incomplete grades can only be
given in case of illness and
personal emergency. Students
must request an Incomplete grade
and receive the approval of their
supervisor. It is up to the
discretion of each supervising
clinical faculty member whether
or not to grant an Incomplete
grade.
5) In case of an emergency leave
due to illness or personal family
matter, students are required to
notify their supervisor and the
Clinic Program Coordinator.
(There is no need to notify the
front desk.) Faculty directories
listing contact phone numbers are
available in plastic bins located
in both the AOM and ND student
libraries. The Clinic Program
Coordinator can be reached
through the Emergency Leave
Line at 206-834-4189. The
following information must be
provided: name, program, shift,
supervisor, substitute, and reason
for absence. Wallet-sized
reference cards listing these
emergency leave instructions are
located in the same bins as the
faculty directories.
3) An unexcused absence is defined
as not being at a scheduled shift,
and failing to notify the
scheduled supervising clinical
faculty member of your absence
prior to the start of the shift. The
first unexcused absence during a
term will result in the student
clinician being required to
complete three makeup shifts (12
hours). A second unexcused
absence will result in a grade of
“F” for the shift and the loss of
the entire shift’s hours and
patient contacts. The supervising
clinical faculty member may, at
their discretion, accept
notification of an absence after
the start of the clinic shift in the
event of an extraordinary
emergency. Even if the student
calls the supervising clinical
faculty member prior to the
missed shift, the supervisor
reserves the right to define the
missed shift as unexcused
absence and then sanction the
student as described above. This
would occur if, in the estimation
of the supervisor, the reason for
the student’s absence does not
warrant missing the shift.
6) If a student knows she/he will not
be able to come to her/his
scheduled shift during the first
week of a quarter because of
being out of town or other
unusual circumstances, they must
fill out an absence/sub form and
contact the Clinic Assistant prior
to the date of absence. A student
will automatically be given a
grade of failure and dropped
from the shift if no arrangements
41
Student Clinician Handbook, 2003-2004
are made with the Clinic
Program Coordinator by the
second week of the quarter.
PLANNED ABSENCES
1. Fill out the bottom portion of the
form titled ‘Absence/Substitution
Form—Student Clinician’. A separate
form must be filled out for each shift
you will miss. (A sample of this form
is included in the Appendix, page 215.)
Be sure to fill out the bottom portion
completely, including your name, ID#,
today’s date, date of expected absence,
shift, program, and reason for absence.
7) Midwifery students must have a
backup substitution available on
an “immediate notice” basis for
all shifts missed due to their
attendance at a birth.
8) Standard policy on attendance,
evaluation of students and
instructors, professional
behavior, and discipline will
apply at all Bastyr external sites.
Instructors and students will be
issued the usual forms for
documenting these processes.
Instructors at external sites are
aware of internal clinic shift
procedures such as case
preview/review and
documentation guidelines, and
are encouraged to model these
procedures as feasible. The
instructor may develop special
procedures that pertain to the
needs of the site. Registration
for all external sites is done
through the registrar at the usual
time and may, at the supervisor’s
request, include an extra
screening process.
2. Notify your supervisor and have
him/her sign in the appropriate space.
Primary ND clinicians and AOM
interns must secure a substitute to
cover their shift, and the substitute
must sign the form.
3. Primaries are also responsible for
contacting the patients who are coming
in specifically to see them. Patient
phone numbers can be obtained from
the Front Desk. Ask your patients to
contact the Front Desk if they wish to
reschedule their appointments.
Primaries must also notify the
secondary/observation clinicians of
their absence.
4. Secondary/Observation clinicians
must secure a substitute to cover their
shift, and the substitute must sign the
form. In addition, they must notify the
Primary Student Clinician that they
will not be attending the shift.
ABSENCE AND
SUBSTITUTION
5. Once the form has been completely
filled out, submit it to the Clinic
Program Coordinator. The form will
be retained throughout the quarter for
future reference.
It is the responsibility of every student
clinician to inform both their assigned
supervisor and the Clinic Program
Coordinator of any absence from the
clinic, prior to that absence. Please
comply with the following procedures
for both Planned Absences and
Emergency Leaves.
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Student Clinician Handbook, 2003-2004
approval, on any one shift during a
quarter (holidays excluded) will be
subject to the following consequences:
a. The student will lose all clinic
credits/hours/patient contacts for
the entire quarter shift involved,
and receive a grade of F.
b. The quarterly shift will need to
be taken again in its entirety.
EMERGENCY LEAVES
1. If ill or in an emergency situation,
notify your supervisor prior to the shift.
If you don’t know your supervisor’s
phone number, call the Front Desk (206834-4100) and have them page your
supervisor. If he/she is unavailable,
leave a message on his/her voicemail.
Primaries must speak with their
supervisor to discuss care decisions for
patients scheduled during the day of
their absence. Whenever possible, you
should secure a substitute or notify your
co-primary.
SUBSTITUTE/EXTRA HOURS
1. Students receive full credit for all
hours that they substitute for other
students or come in on a float room
basis, which must be pre-approved by
the supervising clinical faculty and
scheduled, if available. Float rooms are
on a space-available basis. Any patient
scheduled in float room must be preapproved by the supervisor for that shift.
There cannot be more than 2 float room
patients during any given shift. Once
written and signed approval from the
supervisor is granted, the student must
present this note to the Assistant Patient
Services Manager before the float
patient can be scheduled.
2. Notify the Clinic Program
Coordinator prior to the shift by calling
the Emergency Leave Line at 206-8344189. Leave a message with the
following information: your name,
program, supervisor, shift, substitute,
and reason for absence. For your
convenience, instructional cards and
directories of faculty phone numbers are
available in plastic bins located in both
the ND and AOM student libraries.
CONSEQUENCES OF ABSENCES
1. Students are required to follow all of
the above procedures for both Planned
absences and Emergency Leaves.
Failure to follow these procedures will
result in loss of clinic credit, hours,
and/or patient contacts.
2. These substitute/extra hours can be
used to make up shift hour deficits.
3. Students should record the
substitute/extra time on the reverse side
of the Time Sheet under the section for
Substitute/Extra hours. No more than 4
hours can be recorded for any 1 shift.
2. Students who are more than 30
minutes late to their assigned shift will
receive a written warning for a 1st event
and need to make up missed time.
Students will receive a clinic sanction
for a 2nd event in the same quarter. (For
more information, please see the section
regarding sanctions, page 44).
4. The supervising clinical faculty on
shift must sign off the hours that day.
5. All patients seen during the
substitute/extra hours count towards the
total patient contact requirement for ND
students of 350 patients. All patients
seen while substituting count towards
the total patient contact requirement for
3. Students who are absent more than 2
days, or 3 days with the supervisor’s pre-
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Student Clinician Handbook, 2003-2004
AOM students of 400 patients. These
patient contacts need to be recorded on a
Summary of Patient Contacts Form,
separate from those used for scheduled
shifts.
daily shift hours and patient
contacts for the shift under
review.
2) Two sanctions on the same shift
will automatically result in
failure grade for that entire shift
with the loss of all patient
contacts and hours obtained on
that shift.
6. Hours that accumulate in the
Substitute/Extra “bank” cannot be used
to construct a shift. These hours can
only be used to make-up shift hour
deficits, or can be stored for future
needs.
3) A student will be issued a
sanction when found to violate
any of the policies of the clinic,
namely, but not exclusively:
7. Sub and Extra hours are
automatically shifted into areas
showing a deficit of hours by the office
of the clinic registration staff, when the
quarterly update is done. ND students
should specify if the sub and extra
hours are for patient care or clinic
assistant.
a.
b.
c.
8. Students may use Interim shift hours
to make up missed shifts during the
preceding quarter(s). To do so, those
hours must be recorded on the Time
Sheet on the reverse side, in the SUB
hours section, not on the Interim Sheet.
Breaching patient
confidentiality.
Removing any patientidentifying information
from the clinic.
Acting in an
unprofessional or
disrespectful manner at
any time, including
when off-shift.
4) The severity of the sanction will
depend on the severity of the
offense and may range from loss
of 4 hours and patient contacts
from one of the student’s shifts to
suspension from the clinic. The
involved supervisor and the
Clinic Medical Director will
determine the type of sanction.
(See further sections for more
details.)
SANCTIONS
1) If a student does not adequately
perform one or more of any of
the critical shift competencies on
any given day, or does not
achieve competency on any two
or more of the non-critical
competencies, the supervisor has
the right to issue a sanction to the
student. This sanction will
normally be preceded with a
written warning to the student by
the supervisor. A second similar
poor performance will result in a
written sanction. A sanction
results in the loss of all of the
5) Sanctions are not grades and
therefore are not subject to
appeal under the appeal of grade
policy. A student may issue a
grievance according to the
grievance procedure as outlined
in the student handbook.
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Student Clinician Handbook, 2003-2004
(Except for unexcused absencePlease refer to the Absence and
Substitution section in this
handbook).
b. Failure to follow the clinic
protocols, policies and
procedures as described in the
Student Clinician Handbook.
c. Failure to follow the instructions
or recommendations of the
supervising doctor/physician.
d. Causing intentional harm to a
clinic patient, neglect of a
patient’s care and safety or any
form of verbal abuse.
e. Inappropriate behavior or
unethical conduct with clinical
faculty, staff, patients or
students.
f. Failure to follow the telephone
contact policies and procedures
(see page 131).
g. Failure to follow Clinic
Handbook charting policies and
procedures.
LOSS OF CREDIT,
SUSPENSION, DISMISSAL
There are specific actions and behaviors
that can result in partial loss of credit,
failure (F) for an entire shift, suspension
and/or dismissal from the clinic.
1) Clinic sanctions result from
violation of clinic policy or
procedure as determined by the
student’s clinic supervisor or any
other clinic supervisor if the
event occurs outside of a shift or
off-site. A supervisor may
choose to issue a warning to the
student in lieu of a sanction, but
upon repeated violation, a
sanction will be issued. A clinic
sanction results in the loss of four
(4) clinic contact hours, and all
patient contacts received during
those hours. The hours and
contacts must be made up. A
written notification of clinic
sanction must be given to the
student by the clinic supervisor,
with a copy to the clinic Medical
Director and the Clinic
registration staff for the student’s
file. If a student receives two (2)
clinic sanctions on one clinic
shift, this will result in a failure
(F) grade for that entire quarterly
shift. The shift will need to be
repeated in its entirety. No
credits, hours, or patient contacts
will be given for the failed shift.
The following violations will result in
loss of clinic credit, suspension, and/or
dismissal, depending on the
circumstances and severity of the
violation. In the case where suspension
or dismissal may be appropriate, the
Clinic Medical Director will make a
recommendation to the Academic Vice
President according to the circumstances
of each incident:
a. Dishonest conduct.
b. Practicing medicine without a
license.
c. Violation of theBastyr Center for
Natural Health Code of Ethics.
d. Breach of patient confidentiality
(which includes the removal of
any identifying patient material
from the clinic).
2) The following violations may
result in a clinic sanction:
a. Failure to follow the clinic
absence/substitution policy.
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Student Clinician Handbook, 2003-2004
Failure to convert an Incomplete or
Partial Competency for a clinic shift to
Achieved Competency within 1 quarter
will result in:
a. A Failure for the shift in
question, with loss of all hours
and patient contacts. The shift
will need to be repeated in its
entirety.
b. It is the student’s responsibility
to complete the requirements,
and take care of the paper work.
Contact the Clinic Registration
Staff.
2. If a student has a concern about
something that happens while on
a clinic assistant rotation in the
lab, they should first discuss the
matter in private with the
supervisor. If it is not resolved,
they must meet with their
advisor. If still not resolved, then
they should type a letter about it
to the Clinic Medical Director
and set up a meeting to discuss it
with the Medical Director.
3. If a student has a concern about
something that happens while on
an external clinic shift or
preceptorship, they should first
discuss the matter in private with
the supervisor. If it is not
resolved, they must meet with
their advisor. If still not
resolved, then they should type a
letter about it to the Medical
Director and set up a meeting to
discuss it with the Medical
Director.
Please note: This is not subject to the
grade appeal process. If a student has a
concern, please refer to the grievance
policy.
CLINIC GRIEVANCE POLICY
FOR STUDENTS
This policy is designed to establish a
method whereby students, clinical
faculty, residents and other staff can
voice their concerns and feelings about
policies, procedures or other concerns in
a way that they will be heard, and the
concern can be dealt with in a fair
manner.
4. If a student has a concern about a
policy or procedures, or clinic
operations in general, please type
a letter about it to the appropriate
Clinic Department Coordinator
and set up an appointment to
discuss it with the Clinic
Department Coordinator. If still
not resolved, then they should
forward their letter along with an
explanation from the Clinic
Department Coordinator to the
Medical Director and set up a
meeting to discuss it with the
Medical Director.
1. If a student has a concern about
something that happens while on
a patient care shift, they should
first discuss the matter in private
with the supervising clinical
faculty. If it is not resolved, the
student must meet with their
advisor. If it is still not resolved,
then they should type a letter
about the issue to the Clinic
Medical Director and set up a
meeting to discuss it with the
Medical Director.
5. If a student has a concern about
hours, number of shifts, credits,
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Student Clinician Handbook, 2003-2004
registration, clinic grades or
attendance, please see the clinic
registration staff.
President for final guidance and
resolution.
CLINIC GRIEVANCE POLICY
FOR PATIENTS
6. If a student has a concern about
the preceptor program, this
should be addressed to the
Preceptor Coordinator.
1. In the event that a patient has a
grievance, s/he is directed either
by the supervising doctor in
attendance or by the student
clinician to fill out a comment
form located in the patient
waiting area. The forms are
clearly labeled and displayed.
The completed form is then
routed to either the Clinic
Administrator, if the comment is
business related, or to the
Medical Director, if the comment
is related to health care services.
The matter is then addressed by
one of these two individuals or
delegated out to a third party.
Once the patient’s concern is
addressed, s/he is notified in
writing of the outcome.
7. If any issue or concern cannot be
satisfactorily resolved by a
meeting with the Clinic
Department Coordinator,
Preceptor Coordinator and/or
clinic registration staff, then the
original letter and subsequent
written reviews of the issue from
the Clinic Department
Coordinator, Preceptor
Coordinator and/or Clinic
registration staff will go to the
Clinic Medical Director.
8. If the issue cannot be
satisfactorily resolved by the
Clinic Medical Director, all
written materials along with a
written letter from the Medical
Director will go to the Dean of
Clinical Affairs for review.
2. In addition to the patient filling
out comment forms, many minor
grievances are handled by the
patient service department of the
clinic and the front desk staff.
Upon a patient’s first visit to the
Bastyr Center for Natural Health,
patient services provides the
patient with a two-sided New
Patient Information handout. On
this handout is a list of Patient
Rights and Responsibilities. One
of the rights and responsibilities
listed on this handout is that
“patients have the right to bring
questions, concerns, complaints
or compliments about any aspect
of one’s care or service to the
individual provider, their health
9. If any issue or concern cannot be
satisfactorily resolved by a
meeting with the Dean of
Clinical Affairs, then the issue
and all accompanying materials
will go to the Vice President of
Academics.
10. If any issue or concern cannot be
satisfactorily resolved by a
meeting with the Dean of
Clinical Affairs, then the issue
and all accompanying materials
will go to the Executive Vice
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Student Clinician Handbook, 2003-2004
plan, or provider network”.
Therefore, the patient is informed
in writing of the right to bring
forth any grievances that may
arise.
Please refer to the Student
Handbook for other information
regarding grievances, sanction and
appeals policies.
48
Student Clinician Handbook, 2003-2004
regarding any issues
identified on daily feedback.
PERFORMANCE
EVALUATIONS
c. If a student is not achieving
competency, it is the
responsibility of the
supervisor to notify the
student in writing. The
deficiencies in performance
must be clearly and
specifically noted and
appropriate recommendations
for correcting the deficiencies
must also be given. This
notification should be given
with adequate time left in the
quarter for the student to
correct the deficiencies. In
general, notification within
the 4th – 8th week of each
quarter (mid-quarter) will be
considered sufficient. A
student may still receive a
failure after the 8th week,
without having received prior
written notification, if the
deficiencies of performance
or behavior began or are
identified after the 8th week.
1. In order to enter the clinical
training program, students
(including Advanced
Standing/Transfer students) are
required to receive an AC in all
clinic entry courses. Taking and
passing a clinic entrance exam is
required to receive an AC in
Clinic Entry I (AOM/Nutrition)
and Clinic Entry II (ND).
2. Evaluation of performance is an
essential part of each student’s
training. Performance evaluation
is done in the following way:
a. Each quarter, the supervising
doctor/acupuncturist/R.D.
clinical faculty on each shift
will evaluate students. This
evaluation consists of an
objective and a subjective
section. One of the following
grades can be given on each
shift:
W – withdraw
IP – in progress
F - Failure
I – Incomplete
PC – partial competency
AC – achieved competency
d. Some students may be asked
to participate in a
standardized patient pilot
program. The Center is
currently in the second year
of standardized patient exams
for transitioning from
secondary to primary status
as well as an exit exam. It is
anticipated that these exams
will be required for all ND
students in the future.
b. Each supervisor may use a
daily evaluation checklist that
coincides with the evaluation
form at the end of the quarter.
Students can receive daily
feedback on their
performance. Students are
encouraged to follow-up with
supervisors and/or advisors
49
Student Clinician Handbook, 2003-2004
competency progressively
increases as the student
progresses through her/his
clinical rotation. These
increasing performance
expectations are generally
defined in the clinical
competency section of the
Student Clinician Handbook.
Please note that competency
based grades are not based on
an averaging of clinical
skills, but rather that each one
of the clinical categories has
been successfully mastered at
the appropriate level as
assessed by the supervising
clinical faculty.
Additionally, there are certain
critical clinical skills that
must be competently
demonstrated in order to
achieve an AC grade. Any
one of these critical clinical
skills that is not demonstrated
successfully over the course
of the shift as assessed by the
supervising clinical faculty
will result in an F grade. PC
grades may be given if one of
the non-critical clinical skills
is not demonstrated
successfully. More than one
of the non-critical, yet
essential clinical skills not
competently demonstrated
over the course of the shift
will result in an F grade.
GRADING
1. Grading in the clinic is based on
an achieved competency system.
Each student must receive a
grade of achieved competency in
order to get credit for a shift and
move on to the next shift.
a. Clinic, as part of academics,
uses the same grading system
as established for the didactic
part of academics. This is a
competency based grading
system.
b. The achieved competency
grading system is not the
same as the pass/fail grading
system. Be certain to
understand this difference.
Essentially a grade of AC
means that all clinical skills
for each level have been
successfully mastered, as
appropriate to the student’s
current status in the clinic.
c. The clinical skills a student
must demonstrate mastery of
are listed on the Primary and
Secondary/Observing student
evaluation forms, located in
the clinical faculty offices.
The clinical faculty is
responsible for evaluating a
student for competency on
each of the clinical categories
on the evaluation form. The
student’s current status in
clinic is taken into account
when clinical faculty are
evaluating a student’s
competency. The level of
skills that must be
demonstrated to achieve
2. The senior supervising clinical
faculty person on each shift is
responsible for the evaluation and
grading of students on their shift.
3. Currently, the clinical faculty uses a
comprehensive evaluation form for
50
Student Clinician Handbook, 2003-2004
each department of the clinic. There
are a number of criteria that are used
to evaluate the student’s performance
and competency on each clinic shift.
Please refer to the Appendix for
copies of the evaluation forms.
end of the eighth week of the
quarter the shift is taken. A letter
from the department chair
explaining the reason and giving
approval for the withdrawal is
required. An approved withdraw
allows a student to keep all
patient contacts. Hours
completed to date can be used as
sub/extra hours. The only
exception to this is in the event
that prior to a withdrawal, the
student received a mid-quarter
letter identifying areas of
deficient competency. In this
case, all patient contacts and
hours prior to the withdraw will
be forfeited. Note: When a shift
is officially dropped by a student
after the deadline, the result will
be a loss of all clinic
credits/hours/patient contacts for
the entire quarter shift involved.
a. Each week the supervising
clinical faculty will evaluate the
students on her/his shift.
Utilizing the criteria from the
performance evaluations, written
feedback may be given to
students on a weekly basis.
Students are encouraged to
follow up regarding the feedback
with the supervisor and/or
advisor.
b. At the end of the quarter, all this
information will be used to fill
out the quarterly performance
evaluation form. This quarterly
evaluation also has a subjective
section to be filled out by the
supervising clinical faculty.
b. In Progress (IP): A student has
Achieved Competency but
doesn’t have enough patient
contacts or hours on a quarterly
shift (greater than 80% but less
than 100% hours but still AC
level work). Once 100% of
hours and/or patient contact
requirements are met, the grade
will be changed to an AC.
c. A student can receive a quarterly
grade of:
W - Withdraw
IP - In progress
F - Failure
I - Incomplete
PC - Partial competency
AC - Achieved competency
c. Failure: A student fails to
satisfactorily demonstrate
competency as appropriate for
current clinic status for any of the
critical clinical categories or
more than one of the non-critical
clinical categories listed on the
evaluation form. There is a loss
of all clinic credits, hours and
patient contacts for the shift. The
shift must be made up in its
4. Here is a brief summary of what
each grade means:
a. Withdraw: A student officially
withdraws by notification to the
Clinic registration staff, who will
then notify the registrar.
Withdrawal requests are for
emergency purposes only and
must be done no later than the
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Student Clinician Handbook, 2003-2004
entirety, in the Bastyr Center for
Natural Health. The student will
be on academic probation. One
(1) unexcused absence will result
in an automatic failure. See
absence policy. Two (2)
quarterly shift failures in the
same year automatically places
the student on academic
probation. In addition, the clinic
medical director, program
coordinator, and program chair
(if applicable) will make a
recommendation to the
Academic Standards Committee
regarding possible dismissal
from the University. In the event
that the student is not dismissed,
a learning contract will
developed for the student. They
must successfully meet the
requirements of the learning
contract in order to avoid
dismissal.
stating that they are ill and/or
written documentation of
personal emergency.
e. Partial Competency: The critical
clinical categories were
demonstrated successfully;
however, one of the non-critical
clinical categories was not
competently demonstrated,
appropriate to student’s current
clinic status. The supervisor who
gave the PC will submit written
requirements to the student all of
which the student must
satisfactorily complete in order to
change the PC to an AC. The
student must complete the
requirements necessary to bring
the PC grade to an AC grade by
the end of the following quarter.
f. Achieved Competency: The
successful demonstration of
mastery of all the clinical
categories listed on the
evaluation form, appropriate to
the student’s current status in the
clinic.
d. Incomplete: In order to receive
an Incomplete (“I”) grade for a
clinic shift, a student must
contact the Clinic registration
staff and shift supervisor.
Students receive an Incomplete
only for medical or other
verifiable emergencies. An
Incomplete is given only when
the student is doing satisfactory
work, but cannot complete the
requirement because of a serious
illness or personal emergency.
An Incomplete is not given if a
student is failing a class or clinic
shift. All Incomplete grades
must be successfully completed
by the end of the third week of
the following quarter, or they
will convert to an F. Students
must provide a doctor’s letter
5.
6.
A grade needs to reflect what a
student earns for a particular
quarter without any
contingencies. There are to be
no contingencies that carry over
into the next quarter. The
student will receive a
performance evaluation for
her/his performance each quarter.
Specific student performance
concerns are discussed at every
clinical faculty meeting.
a. The purpose of these confidential
discussions is to review the
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Student Clinician Handbook, 2003-2004
Registrar's Office (for student’s
clinic file).
objective and subjective
evaluations of students in order
to identify the strengths,
weaknesses, and areas of concern
and recommendations. All of
these concerns are discussed in
order to find ways to
appropriately evaluate students
and to strategize ways to improve
the student’s chances of success
in their clinical training.
a. A student should be given
sufficient notice so that she/he
may have time to improve in the
areas of concern. In general,
notification within the 4th to 8th
week of each quarter will be
considered sufficient notice. A
student may still receive a failure
after the 8th week, without having
received prior written
notification, if the deficiencies of
performance or behavior began
or are identified after the eighth
week.
b. This information is recorded by
the Clinic registration staff and is
kept confidential in the registrar's
office.
c. Any students who needs followup from this meeting will be
identified. Either their clinic
supervisor, their advisor, the
Clinic Medical Director or clinic
registration staff will follow up
with the student depending on
the issues involved. If necessary,
the clinic registration staff will
give a written summary of the
comments from the meeting to
either the supervisor or the
advisor. The supervisor or the
advisor may set up a meeting
with the student to discuss the
issues and strategies raised.
b. The notification letter must
identify each area of concern and
must give clear guidelines as to
how the student needs to improve
and what is required in order to
achieve competency.
c. Students must meet with their
supervisor and/or advisor if they
receive notice of risk of failing a
shift. It is solely the student’s
responsibility to arrange this
meeting.
8. Grades are kept in the student’s files
in the Clinic registration staff’s
office. If a student has a question
about her/his grades, please make an
appointment with the clinic
registration staff to review the
grades. These files are confidential.
7. Students who are at risk for failing
the shift must be notified in writing
(mid-quarter letter) by their
supervising clinical faculty before
the end of the quarter, unless this risk
is not evident until the end of the
quarter. A copy of this letter will
also be given to the student’s
advisor, the Clinic Medical Director,
the Program Chair (of the program
applicable to the student) and to the
9. If a student wishes to file a grievance
or appeal a clinic grade, they must
follow the University’s academic
grievance and appeal of grade
procedure as outlined in the Student
Handbook.
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Student Clinician Handbook, 2003-2004
An AC grade is given if the student has
successfully demonstrated competency
in all the clinical categories appropriate
to his/her status in the clinic. A PC
grade is given if critical clinical skills
are successfully demonstrated and one
non-critical skill is assessed as
unsatisfactory. An F grade is given if
one or more critical clinical skills is
assessed as unstaisfactory, or if two or
more non-critical skills are assessed as
unsatisfactory at a level appropriate to
the student’s status in the clinic. If a PC
grade is given, a letter detailing
requirements for changing the PC grade
to an AC must accompany the grade.
See the Clinic SOP and Grading Manual
for details.
GRADING MANUAL (ND
PROGRAM)
Grading criteria for primary and
secondary clinicians are outlined in this
section. It is important for the
supervisor to be aware of the number of
shifts completed by the student at the
beginning of each quarter. A list of
shifts completed and attendance records
are supplied by the Registrar’s Office.
Please note this number on your
attendance sheet. For our purposes, an
early primary is a clinician who has been
primary for 0-2 quarters, usually
corresponding to patient care shifts 5-8.
A mid-primary clinician is working on
patient care shifts 9-12 and a late
primary is working on shifts 13-17.
Naturally, an early primary clinician will
demonstrate less skill in all areas than a
late primary, and the grading system
must take this into account.
Skills identified with an * are critical
clinical skills, others are essential skills.
*1. Initiative and responsibility in patient
care
*2. Communication skills and rapport
with patients
*3. Interviewing skills
*4. Physical exam skills
*5. Overall case management skills
*6. Charting technique (completeness
and clarity)
*7. Application of academic learning to
clinic training and patient care
*8. Differential diagnosis/assessment
skills
*9. Knowledge of Naturopathic
therapeutics and their proper application
*10. Patient follow-up care
11. Listening skills
12. Time management skills
13. Cooperation with clinic supervisors
and staff
14. Communication skills with peers and
supervising doctors
15. Motivation and initiative in learning
clinical skills
Secondary clinicians can also be thought
of as early secondary and late secondary
clinicians. The supervisor’s evaluation
should reflect where a student is along
this spectrum. Increasing expectations
of advancing clinicians are appropriate.
A PC in any area of skill on the final
grade implies that the student has been
made aware of the deficiency in writing
during the quarter and was unable to
improve sufficiently to warrant an AC
grade. It is the supervisor’s
responsibility to communicate to the
student clearly and in writing when a PC
is pending, and to note how the skill may
be improved. If a student is failing a
specific category, a warning letter is
necessary to advise the student. See
section regarding mid-quarter letter or
warning letters, page 49.
Section A – Primary Clinicians
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Student Clinician Handbook, 2003-2004
16. Familiarity with clinic policies and
procedures and efficiency in following
them
The student receives a PC grade if:
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
70-79% of cases.
Mid Primary - demonstrates the above
skills, with minimal coaching from
supervisor on
70-79% of cases.
Late Primary – demonstrates the above
skills, without coaching, on 70-79% of
cases.
1. Initiative and responsibility in Patient
Care
Skills that must be demonstrated in this
category to receive an AC:
The student demonstrates overall
initiative and responsibility in all areas
of patient care as judged appropriate by
the supervisor. These areas may include,
but are not limited to:
The student researches the condition for
FOC and ROC and can demonstrate their
research by exhibiting clear
understanding of the pathophysiology,
biochemistry and a differential diagnosis
during case discussion.
The student has read and reviewed
existing chart notes and is familiar with
current and past treatment plans and
outcomes.
The student initiates study and outside
prep work and will meet the supervisor
to discuss patient cases and treatment on
their own initiative as necessary.
The student comes to case preview and
review prepared to discuss all cases.
The student makes note of medical
records ordered and has reviewed them
by the patient’s next visit after their
arrival.
To rectify a PC, the student is given two
cases to evaluate. The student prepares
and meets the faculty to discuss
pathophysiology, appropriate
biochemistry, diagnostic testing and
physical exam as well as ddx and
ND/MD treatment commonly utilized
for the conditions.
The student receives an F grade if:
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
less that 70% of cases.
Mid Primary – demonstrates the above
skills, with minimal coaching from
supervisor, on less than 70% of cases.
Late Primary – demonstrates the above
skills, without coaching, on less than
70% of cases.
2. Communication Skills and Rapport
with Patients
The student receives an AC grade if:
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
at least 80% of all cases
Mid Primary – demonstrates the above
skills, with minimal coaching, on at least
80% of all cases.
Late-Primary – demonstrates the above
skills, without coaching, on at least 80%
of all cases.
Skills that must be demonstrated in the
category to receive an AC:
The student speaks clearly to the patient.
The student demonstrates active
listening while interviewing the patient.
The student demonstrates empathy with
the patient.
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Student Clinician Handbook, 2003-2004
The student conducts self in an open,
non-judgmental way to all information
disclosed by the patient.
The student addresses all stated concerns
of the patient.
The student attempts to ascertain and
address the unstated needs/concerns of
the patient.
Mid Primary – demonstrates above
skills, with minimal coaching, on less
than 70% of cases.
Late Primary – demonstrates above
skills without coaching, on less than
70% of cases.
The student receives an AC grade if:
Skills that must be demonstrated in this
category to achieve AC:
3. Interviewing Skills
Early Primary – demonstrates all of the
above skills, with coaching from
supervisor on at least 80% of cases.
Mid Primary – demonstrates the above
skills, with minimal coaching, on at least
80% of cases.
Late Primary – demonstrates the above
skills, without coaching, on at least 80%
of the cases.
The student obtains a thorough case
history from the patient, as detailed in
“A Guide to Physical Examination and
History Taking” by Bates, including, but
not limited to:
History of the present illness (HPI)
Past medical history
Current Health Status
Family History
Psychosocial History
Review of Systems
Current medications and supplements
The student receives a PC grade if:
Early Primary – demonstrates all of the
above skills, with coaching from
supervisor, on 70-79% of the cases.
Mid Primary – demonstrates all of the
above skills, with minimal coaching, on
70-79% of cases.
Late Primary – demonstrates all of the
above skills, without coaching, on 7079% cases.
The student demonstrates the ability to
perform special interview techniques in
areas such as gynecology, drug and
alcohol dependence, STD risk profile,
psychological risk and history, etc.
The student demonstrates the ability to
ask questions to ascertain the present
risk to patient safety and safety of others
when indicated.
To rectify a PC grade the student will
conduct 5 interviews and successfully
demonstrate the skills listed above on at
least four of them.
The student demonstrates the ability to
efficiently assimilate the written and
verbal information gathered during the
patient visit and maximize use of visit
time.
The student receives an F grade if:
Early Primary – demonstrates all of the
above skills, with coaching from
supervisor, on less than 70% of the
cases.
The student receives an AC grade if:
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Student Clinician Handbook, 2003-2004
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
at least 80% of all cases.
Mid Primary – demonstrates all of the
above skills, with minimal coaching on
at least 80% of all cases.
Late Primary – demonstrates the above
skills, without coaching, on at least 80%
of cases.
The student shows the ability to perform
any exam on request of supervisor, or as
indicated by patient chief complaint,
within a reasonable time frame.
The student has equipment in all
working order.
The student notifies the supervisor of all
positive finding in time to be reviewed
by the supervisor.
The student shows the ability to perform
the exam and adapt to individual patient
circumstances and comfort.
The student always has appropriate
faculty supervision before performing
any male or female genital exam.
The student receives a PC grade if:
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
70-79% of cases.
Mid Primary – demonstrates the above
skills, with minimal coaching on 70-79%
of cases.
Late Primary – demonstrates the above
skills, without coaching, on 70-79% of
cases.
The student receives an AC grade if:
Early Primary – demonstrate above
skills on 80% of cases. They may
require prompting on 2-3 components of
the exam. They may require more time
to prepare and perform the exams.
Mid Primary – they complete the exam
in allotted time and demonstrate
adequate technique on at least 80% of
cases. They will require no prompting
when they have preparation time and
minimal prompting without preparation.
Late Primary – they demonstrate skill
level of graduating physician, complete
the exam in allotted time and require no
prompting on 90% of cases.
To rectify a PC grade, the student will
participate in three mock interviews to
demonstrate the above skills. The
conditions utilized in the interview will
be taken from the condition list in the
clinic notebook. The student will be
successful on at least two of the cases.
The student receives an F grade if:
Early Primary – demonstrates the above
skills, with coaching from supervisor, on
less that 70% of cases.
Mid Primary – demonstrates the above
skills, with minimal coaching, on less
than 70% of cases.
Late Primary – demonstrates the above
skills, without coaching, on less that
70% of cases.
4)
The student receives a PC grade if:
Early Primary – they demonstrate the
above skills 70 –79% of cases and
require prompting on more than three
components of the exam.
Mid Primary – demonstrate 70 –79% of
cases. They should require no
prompting when they have had
preparation time and minimal prompting
without preparation.
Late Primary – they demonstrate the
above skills on 80 –89% of cases. They
Physical Exam Skills
Skills that must be demonstrated in this
category to achieve AC:
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Student Clinician Handbook, 2003-2004
Early primary – they demonstrate
proficiency, with coaching from
supervisor, on at least 80% of the cases.
Mid primary – they demonstrate
proficiency, with minimal coaching and
increasing depth and breadth of plan, on
at least 80% of the cases.
Late primary – demonstrate graduate
level proficiency on at least 80% of
cases.
should have the skill level of graduating
physicians, complete the exam in
allotted time and require no prompting.
To rectify a PC the student must perform
three exams, reflecting appropriate skill
level, during interim or substitute shifts.
The students receives an F grade if:
Early Primary– they demonstrate the
above skills, with supervisor assistance,
less than 70% of the time.
Mid Primary – they demonstrate the
above skills, with minimal assistance,
less than 70% of the time.
Late Primary – they demonstrate the
above skills, without assistance, less
than 70% of the time.
The student receives a PC grade when:
Early primary – they demonstrate the
above skills on 70 –79% of cases, with
assistance of their supervisor.
Mid primary – they demonstrate the
above skills, with minimal assistance, on
70-79% of cases.
Late primary – they demonstrate the
above skills, at graduate physician level
of competence, on 70-79% of the cases.
5. Overall Case Management
Skills that must be demonstrated in this
category to achieve an AC:
To rectify a PC grade, the student would
present treatment plans for 3 FOC cases
presented by supervisor and adapt the
plans through two ROCs as presented by
supervisor. The plans will represent
appropriate complexity and knowledge
of pathophysiology representative of
current education status.
The student demonstrates understanding
of treatment plan goals by monitoring
patient progress and suggesting
alterations to the plan when indicated.
The student indicates understanding of
the goals of case management by
following up on referrals, diagnostic
testing results, and recommending
changes to the plan as indicated by
patient needs.
The student follows up patient case
management with authorized telephone
calls to the patient to monitor treatment
progress, when indicated.
The student indicates understanding of
the impact of treatment pathophysiology
when recommending alterations to the
treatment plan.
The student receives an F grade when:
Early primary – they demonstrate the
above skills, with prompting, on less
than 70% of the cases.
Mid primary – they demonstrate the
above skills, with minimal prompt on
less than 70% of the cases.
Late primary – they demonstrate the
above skills on less than 70% of cases.
6. Charting Techniques
The student receives an AC grade when:
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Student Clinician Handbook, 2003-2004
Early primary – the above skills are
demonstrated, with correction by
supervisor, on at least 80% of charts.
Mid primary – the above skills are
demonstrated, with minimal correction,
on at least 80% of charts.
Late primary – the above skills are
demonstrated, without correction, on at
least 80% of charts.
Skills that must be demonstrated in this
category to achieve an AC:
Charting is completed within 24 hours of
patient visit unless exception is approved
by supervisor. Corrections made to
chart, as directed by supervisor, are
completed within 24 hours of
notification, unless exception is granted
by supervisor.
Chart notes with basic case information,
including assessment and plan, are left in
the incomplete chart.
Chart is presented in proper soap format
and organized properly in the chart
folder. Each complaint is identified and
information about that complaint listed
separately from other complaints.
Chart is legible and completed in black
ink.
FOC chart utilizes accepted forms with
patient name, date of birth and date of
visit on each page.
On an ROC chart, each page is dated and
identified with patient name and DOB.
If more than one page is used, each page
is numbered and identified.
The patient summary is completed for
each visit.
The supplement/medication sheet and
adult health data sheets are updated at
each visit.
The student utilizes medical terminology
in all sections of the chart.
There are minimal grammatical and
spelling errors, including medications.
Treatment plans include rationale,
dosage and contraindications of
medications when appropriate. The also
include all activities and update all
ongoing treatment. Each treatment plan
should stand alone.
The student receives a PC if:
Early primary – the above skills are
demonstrated, with correction by
supervisor, on 70 – 79% of charts.
Mid primary – the above skills are
demonstrated, with minimal correction
by supervisor, on 70-79% of charts.
Late primary – the above skills are
demonstrated, without correction, on 7079% of charts.
To rectify a PC grade, the student must
write up three properly completed charts.
They must be submitted within the time
deadline decided by supervisor. The
charts must be completed on patient
visits when acting as a substitute
clinician or during interim clinic.
A failure is received when the student:
At all levels, meets the above standards
less than 70% of the time.
7. Application of academic learning to
clinical training and patient care.
Skills which must be demonstrated in
this category to achieve an AC:
The student must demonstrate
understanding of the pathophysiology,
anatomy and biochemistry as they relate
to patient complaints and diagnosis in
case discussion, preview and review.
Demonstrate the ability to triage acute
patient presentations.
The student receives an AC if:
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Student Clinician Handbook, 2003-2004
Mid primary – above skills are
demonstrated, with minimal assistance,
on less than 70% of cases.
Late primary – above skills are
demonstrated, without assistance, on less
that 70% of cases.
8. Differential Diagnosis/Assessment
Skills
Regularly demonstrate evidence of case
preparation by including research about
conditions in case discussions.
Demonstrate understanding of laboratory
and diagnostic testing results and their
impact on diagnosis and treatment.
Demonstrate understanding of
psychological component of patient
complaints and diagnoses and methods
of intervention.
Skills which must be demonstrated in
this category to achieve an AC include:
The student receives an AC grade if:
Student must be able to create a problem
list, a DDX list and make an appropriate
diagnosis.
If a diagnosis or condition is listed on
the assessment as a rule out, a
mechanism should be included in the
plan for ruling out the condition.
The plan should include the steps
necessary to arrive at a definitive
diagnosis.
The problem list should include patient
concerns not addressed by that day’s
treatment which may be indicated by
medical history.
Diagnoses should be carried forward in
the chart for each visit until resolved.
The differential diagnosis list should
include the most probable and most
potentially serious diseases which may
be the diagnosis.
Early primary – they demonstrate the
above skills, with assistance from
supervisor, on 80% or more of cases.
Mid primary – they demonstrate above
skills, with minimal assistance, on 80%
or more of cases.
Late primary – they demonstrate the
above skills, without assistance, on at
least 80% of cases.
The student receives a PC if:
Early primary – above skills are
demonstrated, with assistance from
supervisor, on 70-79% of cases.
Mid primary – above skills are
demonstrated, with minimal assistance,
on 70-79% of cases.
Late primary – above skills are
demonstrated, without assistance, on 7079% of cases.
The student receives an AC if:
To rectify a PC grade, the student must
demonstrate knowledge of above skills,
on two cases from the required
conditions list, to supervising faculty.
Early primary – they demonstrate above
skills, with assistance from supervisor,
on 80% or more of cases.
Mid primary – they demonstrate above
skills, with minimal assistance, on at
least 80% of cases.
Late primary – they demonstrate above
skills, without assistance, on at least
80% of cases.
Student receives an F grade if:
Early primary – above skills are
demonstrated, with assistance from
supervisor, on less than 70% of cases.
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Student Clinician Handbook, 2003-2004
The student receives a PC grade if:
The student is familiar with the contents
of supplement formulas intended for use
or previously prescribed for the patient.
The student is able to identify all of our
modalities available for treatment of the
individual patient and their condition
and to discuss rationale for use of those
modalities.
The student is able to recommend
dosages of supplements, botanicals and
homeopathics in a safe and therapeutic
range.
The student is able to incorporate the use
of Naturopathic principles into a
treatment plan and can discus how the
principles are integrated into the plan.
Early primary – they demonstrate above
skills, with assistance, on 70 – 79% of
cases.
Mid primary – they demonstrate above
skills, with minimal assistance, on 70 –
79% of cases.
Late primary – they demonstrate above
skills, without assistance, on 70 – 79%
of cases.
That may rectify a PC grade by
demonstrating appropriate skill at
differential diagnosis on four cases
presented by the supervising faculty.
The student receives an F grade if:
The student receives an AC grade if:
Early primary – demonstrates all of the
above skills, with coaching from
supervisor, on at least 80% of the cases.
Mid-primary- demonstrates all of the
above skills, with increased depth of
knowledge and minimal coaching, on at
least 80% of the cases.
Late primary – demonstrates all of the
above skill, with the depth of knowledge
of a graduating clinician and
demonstrates increased versatility with
therapeutic agents. The student is able
to develop a treatment plan, without
supervision, on at least 80% of cases.
Early primary – they demonstrate above
skills, with assistance, on less than 70%
of cases.
Mid primary – they demonstrate above
skills, with minimal assistance, on less
than 70% of cases.
Late primary – they demonstrate above
skills, without assistance, on less than
70% of cases.
9. Knowledge of Naturopathic Therapies
and their Proper Application:
Skills that must be demonstrated in this
category to achieve AC:
The student receives a PC grade if:
Early primary – demonstrates all of the
above skills, with coaching, on 70 – 79%
of cases.
Mid primary – demonstrates all of the
above skills, with increased depth of
knowledge, on 70 – 79% of cases.
Late primary – demonstrates all of the
above skills, with increased depth of
knowledge, versatility with therapeutic
agents and without supervision from
supervisor, on 70 – 79% of cases.
The student prepares therapeutic options
for each case before preview and is able
to discuss rationale, strategy and
therapeutic goals.
The student demonstrates the ability to
choose appropriate therapies to suit
individual patient circumstances.
The student is able to prepare a
treatment plan in an acute situation
within the given time constraints.
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Student Clinician Handbook, 2003-2004
To rectify a PC grade the student will be
assigned 5 cases from the supervisors
case load and be required to formulate
specific alternative treatment plans for
the given conditions. These treatments
will be reviewed and discussed with the
supervisor. At least four of the five
cases must demonstrate the skills listed
above.
Early primary – demonstrates the above
skills on greater than 80% of cases with
assistance of supervisor.
Mid primary – demonstrates the above
skills on greater than 80% of the cases
with minimal assistance.
Late primary – demonstrates the above
skills without assistance on more than
80% of cases.
The student receives an F grade if:
Early primary – demonstrates the above
skills with assistance on less than 70%
of cases.
Mid primary – demonstrates all the
above skills, with increasing depth of
knowledge, on less than 70% of cases.
Late primary – demonstrates the
above skills, with increasing depth of
knowledge, on less than 70% of cases.
The student receives a PC grade if:
10.
Early primary – demonstrates the above
skills, with assistance, on 70 – 79% of
cases.
Mid primary – demonstrates the above
skills, with minimal assistance, on yet 70
– 79% of cases.
Late primary – demonstrates the above
skills, without assistance, on 70 – 79%
of cases.
Patient Follow-up Skills
To rectify a PC grade the student must
develop detailed follow-up plans for 5
cases that demonstrate knowledge of
appropriate screening exam intervals and
length of duration of specific therapeutic
agents.
Skills that must be demonstrated in this
category to achieve an AC:
The student demonstrates initiative in
patient follow-up. For example,
pursuing pre-approval of phone calls,
performing additional research on a case
study, integrating appropriate referrals,
etc.
The student meets the supervisor near
the end of the quarter to coordinate
transition for care in the next quarter,
and notifies the patients involved.
The student develops the ability to keep
phone contacts brief and to the point.
The student completes referral letter,
intraclinic referral letter, release of
record forms, future lab forms and any
other necessary paperwork for
continuation of care in a timely fashion.
The student receives an F grade if:
The primary clinician demonstrates the
above skills on less than 70% of cases
despite assistance of supervisor.
11. Listening Skills
Skills that must be demonstrated in this
category to achieve an AC:
The student demonstrates the ability to
hear the patient by giving a summary of
the patient history accurately to the
supervisor.
The student demonstrates the ability to
assimilate and integrate the patient’s
The student receives an AC grade if:
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Student Clinician Handbook, 2003-2004
verbal and written information and
minimize the asking of redundant
questions.
The student demonstrates the ability to
recognize patient concerns even when
they are not clearly articulated by the
patient.
The student will listen to the supervisor
and follow verbal instructions.
A student of any level demonstrates less
than 70% achievement on all of the
above skills.
12. Time Management Skills
Early primary – demonstrates all of the
above skills, with coaching from
supervisor, on at least 80% of cases.
Mid primary – demonstrates all of the
above skills, with minimal coaching
from supervisor, on at least 80% of the
cases.
Late primary – demonstrates all of the
above skills, without coaching, on at
least 80% of cases seen.
Skills that must be demonstrated in this
category to achieve an AC:
The student demonstrates the ability to
take an appropriate history, perform the
appropriate physical exam(s), meet with
supervisor, make an assessment and
diagnosis, create a treatment plan and
explain the plan to the patient in the
allotted period of time.
The student arrives to case preview and
review on time, and participates actively
in both.
The student complies with deadlines in
charting, patient follow-up and
responding to patient and supervisor
requests.
The student receives a PC grade if:
The student receives and AC grade if:
Early primary – demonstrates the above
skills, with coaching on 70 – 79% of
cases.
Mid primary – demonstrates the above
skills, with minimal coaching on 70 –
79% of cases.
Late primary – demonstrates the above
skills, without coaching on 70 – 79% of
cases.
Early primary – demonstrates the above
skills, with supervisor coaching, on at
least 80% of cases.
Mid-primary – demonstrates the above
skills, with minimal coaching, on at least
80% of cases.
Late primary – demonstrates the above
skills, without coaching on at least 80%
of cases.
The student rectifies a PC by taking a
maximum of 3-4 cases, recognizing the
defects in their skills and demonstrating
adequate competency in at least three
cases. A videotape may be made in
these cases and used to demonstrate
areas of inadequacy for the student.
The student receives a PC grade if:
The student receives an AC grade if:
All levels – demonstrates the skills listed
above on 70 – 79% of cases.
A PC may be converted to an AC by
demonstrating successful time
management on all 3 occasions of mock
interviews set up by the student with
supervision. Content of the interview
will be evaluated as well as the time
The student receives an F grade if:
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Student Clinician Handbook, 2003-2004
management aspect. This may also be
accomplished during an interim clinic
shift upon approval of supervisors.
error, omission, conflict or extra work
regarding patient management or
jeopardizes patient rapport, a warning
letter is written to the student on the first
offense. A failure event may also be
given at the discretion of the supervisor.
The student receives an F grade if:
All levels – the student demonstrates the
above skills on less than 70% of patient
visits.
The student receives an F grade if:
13. Cooperation with Clinic Supervisors
and Staff
Additional episodes of deliberate lack of
cooperation occur during the rest of the
quarter.
Skills that must be demonstrated in this
category to achieve AC:
14. Communication Skills with Peers
and Supervising Doctors
The student demonstrates the ability to
work as part of a team, for the well being
of the patient.
The student demonstrates the ability to
interact with all clinic staff, faculty and
colleagues in a professional manner that
optimizes patient care.
The student communicates accurately to
the patient specific recommendations
approved by the supervisor and does not
make treatment suggestions to the
patient without the approval of the
supervisor.
Skills that must be demonstrated in this
category to achieve AC:
The student demonstrates an articulate
and summarized presentation of cases in
preview and review.
The student demonstrates the ability to
summarize the patient’s case to the
supervisor in a complete, coherent and
concise manner.
The student demonstrates the ability to
communicate effectively with their
secondary clinician in a way that best
facilitates case management.
The student communicates relevant
details from the interview which have a
bearing on case management (including,
but not limited to, suicidal thought or a
recent history of an eating disorder or
recent trauma).
The student receives an AC grade if:
Early primary – demonstrates the above
skills, with coaching by the supervisor,
on at least 80% of cases.
Mid primary – demonstrates the above
skills, with minimal coaching from the
supervisor, on at least 80% of cases.
Late primary – demonstrates all of the
above skills, without coaching from the
supervisor, on 80% of cases.
The student receives an AC grade if:
Early primary – demonstrates the above
skills on 80% of cases with supervisor
coaching.
Mid primary – demonstrates the above
skills on 80% of cases with minimal
coaching.
There is no PC grade for this clinical
skill. If a student demonstrates a
deliberate lack of cooperation with
others that results in delay, confusion,
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Student Clinician Handbook, 2003-2004
Late primary – demonstrates the above
skills on 80% of cases without coaching.
using clinic educational resources to
study a condition.
practicing physical exam skills.
reviewing medical references relating to
a patient’s complaint or treatment.
expanding therapeutic knowledge.
familiarizing oneself with dispensary
products and indications for use.
sitting in on case discussions of other
primary clinicians.
The student receives a PC grade if:
Early primary – demonstrates the above
skills on 70 – 79% of cases with
supervisor coaching.
Mid primary – demonstrates the above
skills 70 – 79% of cases with minimal
coaching.
Late primary – demonstrates the above
skills without coaching 70 – 79% of
cases.
The student receives an AC grade if:
Early primary – demonstrates initiative
in the above areas, with direction from
the supervisor, on 80% or more of all
shifts.
Mid primary - demonstrates initiative in
the above areas, with minimal direction,
on at least 80% of all shifts.
Late primary – demonstrates initiative in
the above areas, without direction, on at
least 80% of all shifts.
To rectify a PC grade the student must
meet with the supervisor and present five
cases, successfully demonstrating the
above skills on four out of the five.
The student receives an F grade if:
Early primary - demonstrates the above
skills on less than 70% of cases with
supervisor coaching.
Mid primary – demonstrates the above
skills on less than 70% of cases despite
minimal coaching.
Late primary – demonstrates the above
skills on less than 70% of the cases
without coaching.
The student receives a PC grade if:
Early primary – demonstrates initiative
in the above areas, with direction from
the supervisor, on 70 – 79% of shifts.
Mid primary – demonstrates initiative in
the above areas, with minimal direction
from the supervisor, on 70 – 79% of
shifts.
Late primary – demonstrates initiative in
the above areas, without direction, on 70
– 79% of shifts.
15. Motivation and Initiative in Learning
Clinical Skills
Skills that must be demonstrated in this
category to achieve AC:
To rectify a PC grade a student must be
observed actively enhancing their
clinical skills in the aforementioned
ways during times they are not seeing
patients. The number of hours devoted to
this additional study must equal the
number of hours that were not well spent
on their clinic shift. Other supervisors
The student will demonstrate motivation
and initiative by using clinical time not
taken up with patient care in a way
which enhances clinical skills and
education. This would include, but is
not limited to:
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Student Clinician Handbook, 2003-2004
may assist in keeping track of these
additional hours.
the supervisor or other faculty. No
further violations can occur during the
quarter. There is no rectifying a
violation of certain policies as noted in
the notebook.
The student receives an F grade if:
The student demonstrates the above
skills on less than 70% of all shifts.
The student receives an F grade if:
16. Familiarity with Clinic Policies and
Procedures and Efficacy in Following
Them
Skills that must be demonstrated in this
category to achieve AC:
Any primary clinician who is in
compliance with written policies on less
than 70% of the shifts will receive an F.
This would mean the student has
violated policy on four occasions during
the quarter. There are certain policies in
the notebook which call for immediate
sanction as in loss of one shift (hours
and patient contacts) or in loss of credit
for the quarter. Please review the
notebook.
The student will demonstrate
competency in this area by adhering to
all policies outlined in the clinic SOP
notebook and University policies as
outlined in the handbook.
Section B – Secondary Clinicians
An AC grade is given if the student has
successfully demonstrated competency
(2-4) in all the clinical categories
appropriate to his/her status in the clinic.
A PC grade is given if critical clinical
skills are successfully demonstrated and
one non-critical skill is assessed as
unsatisfactory. An F grade is given if
one or more critical clinical skills is
assessed as unstaisfactory, or if two or
more non-critical skills are assessed as
unsatisfactory at a level appropriate to
the student’s status in the clinic. If a PC
grade is given, a letter detailing
requirements for changing the PC grade
to an AC must accompany the grade.
See the Clinic SOP and Grading Manual
for details.
The student receives an AC grade if:
All primary clinicians must be in
compliance with the written policies on
80% or more of the shifts. This would
allow policy violations on not more than
two occasions during the eleven-week
quarter. There are certain policies and
procedures which may result in
immediate failure of the shift or quarter
when violated. (Example: removal of a
chart from clinic premises. Please review
SOP notebook.)
The student receives a PC grade if:
Any primary clinician who is in
compliance with the written policies on
70 – 79% of the shifts will receive a PC.
This is roughly equal to 3 policy
violations during the eleven-week
quarter.
Skills identified with an * are critical
clinical skils, others are essential skills.
*1. Initiative and responsibility in role as
a secondary student clinician
*2. Cooperation with clinic supervisors
and staff
To rectify a PC the student must pass
with 80% or better an equal quiz on
policies in the SOP notebook given by
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Student Clinician Handbook, 2003-2004
Late secondary – demonstrates above
skills, without assistance, on more than
80% of cases.
*3. Familiarity with clinic policies and
procedures and efficiency in following
them
*4. Physical exam skills
*5. Application of academic learning to
clinic training
*6. General overview of case
management
*7. Listening skills
8. Communication skills and rapport
with peers and supervisors
9. Time management skills
10. Motivation and initiative in learning
clinical skills
11. Participation and input in case
discussions on shift
The student receives a PC if:
Early secondary – demonstrates above
skills, with assistance, on 70 – 79% of
cases.
Late secondary – demonstrates above
skills, without assistance, on 70 – 79%
of cases.
A PC may be rectified by study of two
cases and demonstrating knowledge of
pathophysiology and differential
diagnosis in mock case review with a
supervisor.
1. Initiative and Responsibility in Role
as Secondary Clinician
The student receives an F if:
Skills that must be demonstrated to
achieve an AC include:
Early secondary – demonstrates above
skills, with assistance, on less than 70%
of cases.
Late secondary – demonstrates above
skills on less than 70% of the cases.
The student demonstrates initiative and
responsibility by reviewing
pathophysiology, biochemistry,
differential diagnosis and treatment(s)
for chief complaints listed on a patient
FOC.
The student reviews patient charts for
ROCs and demonstrates understanding
by knowledgeable participation in case
preview.
The student is familiar with each case
seen that day and by case review can
knowledgeably participate and present
cases when requested to do so by
supervisor.
2. Cooperation with Clinical Supervisors
and Staff
Skills which must be demonstrated to
achieve an AC include:
The student demonstrates teamwork by
presenting paperwork needed on shift
and coordinates completion by
supervisor and primary.
The student exhibits knowledge of
location of forms and has adequate
supply on hand for each visit.
Oversees dispensary paperwork
completion and verifies product(s)
chosen are available for the patient.
The student receives an AC if:
Early secondary – demonstrates above
skills, with assistance of supervisor, on
more than 80% of cases.
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Student Clinician Handbook, 2003-2004
Make sure superbill is completed and
signed and processed by departments as
indicated.
Make sure lab requisition and paperwork
is completed and routed for processing.
Transfers any PE information they
gather during visit to primary for
inclusion in the chart.
The student demonstrates teamwork by
active participation to patient
management in appropriate ways with
the supervisor and primary clinician.
(Example: Coordinates their questions to
those of the primary and supervisor in
both content and timing of the
questions.)
Informs front desk staff if visit is
running late.
Informs the dispensary if visit is running
late and a prescription is to be processed
for late patient.
Skills which must be demonstrated for
the student to receive an AC:
The student stocks the exam room with
necessary supplies for each shift.
The student accompanies the patient to
and from restroom, lab, dispensary, front
desk or other designated areas in the
clinic
The student verifies that the patient is
aware of proper specimen techniques.
The student sets up the room to
accommodate any planned procedure
before the visit.
The student notifies waiting patients
when previous visit is running over time
allotted.
The student returns room to order and
replaces used supplies at end of visit.
Returns borrowed equipment to
proper/original location.
The student disinfects room at end of
each patient visit.
The student has clinic paperwork signed
off by the supervisor at the end of each
shift.
The student has knowledge of clinic
SOPs (from handbook) and follows
them.
The student follows proper biohazard
handling and disposal techniques.
The student receives an AC if:
Early secondary – above skills are
demonstrated, with assistance from
supervisor, on 80% of more cases.
Late secondary – above skills are
demonstrated, without assistance, on at
least 80% of cases.
There is no PC for this category
The student receives an AC if:
The student receives an F if:
Early secondary – they perform above
skills, with assistance of supervisor, on
at least 80% of cases.
Late secondary – they perform above
skills, without assistance, on at least
80% of cases.
Early secondary – above skills are
demonstrated, with assistance of
supervisor, on less than 80% of cases.
Late secondary – above skills are
demonstrated, without assistance, on less
than 80% of cases.
There is no PC for this category
3. Familiarity with Clinic Policies and
Procedures and Efficiency in Following
Them
The student receives an F if:
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Student Clinician Handbook, 2003-2004
Early secondary – they perform above
skills, with assistance of supervisor, on
less than 80% of cases.
Late secondary – they perform above
skills, without assistance, on less than
80% of cases.
The student will receive an AC if:
The student, at all levels of experience,
will receive an AC if they perform the
above skills on at least 80% of cases.
The student will receive a PC if:
4. Physical Exam Skills
The student, at all levels of experience,
will receive a PC grade if they perform
the above skills on 70 – 79% of cases.
A PC may be rectified by:
demonstrating appropriate techniques
taking vital signs
appropriate recording of vitals in the
chart
the possession of diagnostic equipment
in good working order
Skills that must be demonstrated for the
student to receive an AC:
The student takes vital signs, using
appropriate technique, for each patient
on each visit.
The student reports vitals to the
supervisor when they are abnormal, and
makes sure the information is recorded
accurately in the chart.
The student repeats exams on patient
when requested to do so by primary
clinician or supervisor.
The student must bring diagnostic
equipment to clinic and have their
equipment in good working order.
All skills to be assessed by the
supervisor on three occasions on a
substitute or interim clinic shift.
The student will receive an F grade if
they perform the above skills less than
70% of the time.
Can actively participate in case
discussions with supervisors and
primary.
5. Application of Academic Learning to
Clinical Training
Skills that must be demonstrated for the
student to receive an AC:
The student will receive an AC if:
Early secondary – perform above skills,
with minimal assistance of supervisor, or
more than 80% of cases.
Late secondary – perform above skills,
without assistance, on more than 80% of
cases.
The student demonstrates understanding
of pathophysiology, anatomy and
biochemistry as they relate to patient
complaints and diagnosis in case
discussion, preview and review.
The student demonstrates evidence of
case preparation by including research
about conditions in cases discussion.
Can explain purpose and function behind
lab or diagnostic testing to patient when
asked to do so
The student will receive a PC if:
Early secondary – perform above skills,
with minimal assistance from supervisor,
on 70 – 79% of cases.
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Late secondary – perform above skills,
without assistance, on 70 – 79% of
cases.
The student can assess and identify
pertinent patient findings.
The student can discuss the significance
that lifestyle modifications would have
for the patient’s health.
The student demonstrates the ability to
prioritize the patient’s concerns.
The student can discuss the case in terms
of the Naturopathic principles and
identify the principles which were and
were not utilized in each case.
A student may rectify a PC by
completing assignment of three case
analyses with supervisor. These cases
will include the following components:
• Identify the chief complaint and
seven attributes
• Describe objective findings
utilizing appropriate terminology
•Be able to formulate and defend a
differential diagnosis and include
testing done to confirm diagnoses.
The student receives an AC grade if:
Early secondary – demonstrates all of
the above skills, with supervisor
assistance, on at least 80% of cases.
Late secondary – demonstrates all of the
above skills, without assistance, on at
least 80% of cases.
The student will receive an F if:
Early secondary – perform above skills,
with minimal assistance from supervisor,
on less than 70% of cases.
Late secondary – perform above skills,
without assistance, on less than 70% of
cases.
The student receives a PC grade if:
Early secondary – demonstrates all the
above, with supervisor assistance, on 70
– 79% of cases.
Late secondary - demonstrates all of the
above, without assistance, on 70 – 79%
of cases.
6. General Overview of Case
Management
Skills that must be demonstrated in this
category to achieve an AC:
To rectify a PC grade the student must
study 3 additional cases and be able to
discuss relevant features of each case
including history, physical exam and
relevant diagnostic findings, assessment
and treatment plan with the supervisor.
The student must demonstrate
proficiency on at least four of the five
cases.
The student exhibits understanding of
case management by participating in
case discussion utilizing knowledge of
pathophysiology, biochemistry to
support the differential diagnoses.
The student can explain the purpose of
any diagnostic tests ordered and the
meaning of the results received and how
they apply to the case under discussion.
The student can formulate treatment
options during case discussion and
support choice of treatment utilizing
clinical thinking skills.
The student receives an F grade if:
Early secondary – demonstrates the
above skills, with supervisor assistance
on less than 70% of cases.
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Late secondary – demonstrates the above
skills, without assistance, on less than
70% of cases.
8. Communication Skills with Peers and
Supervisors
Skills that must be demonstrated in the
category to achieve an AC:
7. Listening Skills
Skills that must be demonstrated in the
category to achieve an AC:
The student actively follows the case
taking and inserts appropriate questions
at indicated times during the visit.
The student notes requests by the patient
during the visit to be fulfilled by the
dispensary or supervisor.
The student observes the patient during
the interview and reports pertinent
observations to the primary and
supervisor.
The student demonstrates
communications skills which emphasize
patient needs and are culturally and
socially sensitive to patient gender,
lifestyle, culture and socioeconomic
status.
The student discusses their role with
primary clinical and supervisor and
elicits feedback on their performance.
The student contributes comments and
questions during case discussion which
contribute to the flow, and reserves
adjunctive questions for later discussion.
The student is able to present a case, in a
concise, summarized, cohesive
presentation, in case review and case
preview within 3 – 5 minutes.
The student receives an AC grade when:
Early secondary – they demonstrate all
of the above skills, with supervisor
assistance, on at least 80% of cases.
Late secondary – they demonstrate all of
the above skills, without assistance, on at
least 80% of cases.
The student receives an AC grade if:
Early secondary – demonstrates all of
the above skills, with supervisor
assistance, on at least 80% of cases.
Late secondary – demonstrates all of the
above skills, without assistance, on at
least 80% of cases.
The student receives a PC grade when:
Early secondary – they demonstrate the
above skills, with supervisor assistance,
on 70 – 79% of cases.
Late secondary – they demonstrate the
above skills, without assistance, on 70 –
79% of cases.
There is no PC given for this clinical
competency.
To rectify a PC grade a student must
successfully present a case preview or
review where the supervisor is present.
The students receives an F grade if:
Early secondary – demonstrates the
above skills, with supervisor assistance,
on less than 80% of cases.
Late secondary - demonstrates the
above skills, without assistance, less
than 80% of cases.
The student receives an F grade when:
Early secondary – they demonstrate the
above skills, with supervisor assistance,
on less than 70% of cases.
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Student Clinician Handbook, 2003-2004
Late secondary – they demonstrate the
above skills, without assistance, on less
than 70% of cases.
10. Motivation and Initiative in Learning
Clinical Skills
9. Time Management Skills
Skills that a student must demonstrate in
this category to achieve an AC:
The student demonstrates self motivation
in researching and expanding their
knowledge base of Naturopathic
medicine by showing an increased
breadth and depth of knowledge in their
contributions to case discussion.
The student uses non-patient clinical
time in a way which enhances clinical
skills and education. This would
include, but not be limited to:
• using library resources to study
a condition
• practicing physical exams
• reviewing medical references
related to patient’s condition or
treatment
• familiarizing oneself with
commonly used diagnostic tests
• reviewing the emergency
treatment kit
• sitting in on other case
discussions
Skills that must be demonstrated in this
category to achieve an AC:
The student assists the primary in
completing the visit on time by
demonstrating appropriate
communication skills, being prepared
with appropriate paperwork, and
efficiently completing any needed
paperwork.
The student acts as a timekeeper for the
primary when needed and informs the
next waiting patient and the front desk if
the visit is running over time.
The student completes vital signs within
5 minutes.
The student completes the paperwork in
a timely manner.
The student has made sure the exam
room is adequately stocked to avoid
delays.
The student arrives on time for the shift.
The student receives an AC grade when:
The student receives an AC grade when:
Early secondary – they demonstrate all
of the above skills, with assistance from
supervisor, on at least 80% of cases.
Late secondary – they demonstrate all of
the above skills, without assistance, on at
least 80% of cases.
Early secondary – they demonstrate all
of the above skills, with supervisor
assistance, on at least 80% of cases.
Late secondary – they demonstrate all of
the above skills, without assistance, on at
least 80% of cases.
There is no PC grade for this clinical
competency.
The student receives a PC grade when:
Early secondary – they demonstrate the
above skills with assistance, on less than
80% of cases.
Late secondary – they demonstrate the
above skills without assistance, on less
than 80% of cases.
Early secondary – they demonstrate all
of the above skills, with supervisor
assistance, on 70 – 79% of cases.
Late secondary– they demonstrate all of
the above skills, without supervisor
assistance, on 70 – 79% of cases.
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Student Clinician Handbook, 2003-2004
The student receives a PC grade when:
To rectify a PC grade the student must
be observed actively enhancing their
clinical skills in the above-mentioned
ways or other ways delineated by
supervisor on non-shift time. The
number of hours devoted to this
additional study must equal the number
of hours that were not utilized well
during the clinic shift. Other supervisors
may assist in keeping track of these
additional hours
Early secondary - they demonstrate all
the above skills, with supervisor
assistance, on 70 – 79% of cases.
Late secondary – they demonstrate all of
the above skills, without assistance, on
70 – 79% of cases.
To rectify a PC grade the student must
attend four additional case preview or
reviews and join in case discussion by
presenting the case of a patient they have
seen, in a concise, summarized, cohesive
presentation (maximum of 5 minutes).
The student receives an F grade when:
Early secondary – they demonstrate the
above skills, with assistance, on less than
70% of cases.
Late secondary – they demonstrate the
above skills, without assistance, on less
than 70% of cases.
The student receives a F grade when:
All levels – they demonstrate the above
skills on less than 70% of the cases.
NOTE ON COMPETENCIES AND
GRADING
11. Participation and Input in Case
Discussions on Shift
In addition to, and separate from
achieving competencies for all clinic
shifts, students are required to
competently perform the skills outlined
in the list of Clinical Competencies.
Skills that must be demonstrated in this
category to achieve an AC:
The student attends case preview and
review and provides input on a
consistent basis and in an appropriate
manner.
The student contributes observations and
input about the case during the case
management discussion, case preview or
review.
STUDENT PROMOTIONS
COMMITTEE
The Student Promotions Committee
consists of faculty from each department
within the university. The Vice
President for Academics and Research,
the Dean of Students and the Registrar
are non-voting members on the
committee. This committee will
evaluate student academic performance
every quarter. The committee will
review records of those students who
have had academic concerns in the
previous quarter(s). The committee will
look at the entire academic record of the
The student receives an AC grade when:
Early secondary – they demonstrate all
of the above skills, with supervisor
assistance, on at least 80% of cases.
Late secondary – they demonstrate all of
the above skills, without assistance, on at
least 80% of cases.
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Student Clinician Handbook, 2003-2004
student and make a determination as to
the appropriate course of action. The
courses of action may include, but are
not limited to, a warning, learning
contract, probation, suspension, or
dismissal.
For more information on dismissal and
other academic policies, please refer to
the Academic Policy Handbook. The
complete Academic Policy Handbook is
located on the shared drive of the library
computer and can be found in all of the
academic offices as well as on the
communications bulletin boards.
Academic Policies are also printed in the
Catalog and the Student Handbook.
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Student Clinician Handbook, 2003-2004
BASTYR CENTER FOR NATURAL HEALTH
CLINIC PROCEDURES, POLICIES AND PROTOCOLS
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Student Clinician Handbook, 2003-2004
Guiltinan (Dean of Clinical
Affairs) will notify Zandi
Salstrom and staff members
will come in to call and
inform patients of the Center’s
closure and post signs on
Center doors.
INCLEMENT WEATHER POLICY
This is a reminder of Center policy and
procedure regarding inclement weather.
1.
2.
a.
b.
c.
In the event of severe inclement
weather conditions, the
Executive Vice President and
the Dean of Clinical Affairs
will together determine Center
closure. Only in the event of
extremely severe weather
conditions will such closure
occur, and every effort will be
made to keep the Center open,
as it is a health care facility
including urgent care.
3.
If there is a power and/or phone
outage, communications with
employees, patients, and students
will be limited. Center staff will
do their best to post signs and have
someone at the Center to deal with
anyone who comes in.
4.
Jennifer Mulford (Operations
Manager) and Steevie Bereiter
(Assistant to the Center Operations
Manager) are trained on how to
change the voice mail message.
5.
Jane Guiltinan (Dean of Clinical
Affairs) is the primary decisionmaker for the Center. Jamey
Wallace (Interim Medical
Director) and Lisa Hopkins (Clinic
Administrator) are secondary
decision-makers for the Center in
case there is lack of clarity over
what we will do. If none of those
people are reachable, Lynne
McCutchen (Executive Assistant
to the Dean of Clinical Affairs)
has been vested with the authority
to make the decision.
If a decision is made to close,
the following will be in effect:
If a decision to close is made
before regular Center business
hours, it will be broadcast on
local radio and television
news broadcasts beginning at
7 AM, the Center main voice
mail message will be updated
by 6 AM, and several staff
members will come in to call
and inform patients of Center
closure and post signs on
Center doors.
If a decision to close is made
during business hours, signs
will be posted immediately on
Center doors, the master voice
mail message will be modified
immediately, patients will be
called and informed of
closure, and the University
will be called to post signs for
students.
If a decision is made to close
on a Saturday, the Center’s
main voice mail message will
be updated up 6 AM. Jane
CONFIDENTIALITY POLICY
1. All patient records at the Bastyr
Center for Natural Health are
confidential and subject to the state and
federal laws regulating the management,
release, maintenance and destruction of
such records. This includes but is not
limited to RCW 70.02 and standards
outlined by the Washington State Health
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Student Clinician Handbook, 2003-2004
Information Management Association
(WSHIMA).
provide healthcare to the patient.
However, since this is a teaching clinic,
patient records may be made available to
student clinicians and attending
providers for the purposes of research,
grand rounds work or instructional use.
2. Only authorized medical records staff
are permitted to release any written
patient information from the clinic or to
authorize transfer of patient records
(such as transfers of x-rays). Release of
such information by students, staff or
faculty is a violation of clinic policy and
grounds for disciplinary actions. See
individual sections for policies
concerning release of records.
6. Patient records for Bastyr students,
LIOS students, clinic and campus staff,
clinic and campus faculty members and
significant others of the same are
available only to student clinicians and
attending providers directly involved in
the individual’s healthcare or responding
to an emergent situation. All other
access, except that necessary for
management and maintenance of the
record by authorized record custodians,
is strictly prohibited. Such ‘restricted’
records are not to be discussed in
preview or review sessions and are never
to be used for case presentations or
grand rounds. This restriction remains on
a record even after a student graduates, a
staff or faculty member leaves the clinic
or a relationship with a significant other
changes. Discussion of any Bastyr
community member’s clinic visits to
anyone not involved in the patient’s care
and for purposes other than the patient’s
care is prohibited.
3. Patient records are maintained for the
mutual benefit of the patient, the
attending healthcare professionals,
student clinicians and the institution. The
physical patient record serves as the
clinic’s official legal record of services
rendered to each patient at our facility
and is property of the Bastyr Center for
Natural Health. The information
contained in the chart includes personal
and sensitive health information and is to
be handled with the utmost prudence. In
addition, all records are subject to clinic
confidentiality policies. Violation of
clinic confidentiality policy is grounds
for disciplinary action.
4. All patient records are to remain in
the building at all times, except under
the lawful practices of the Medical
Records Coordinator. Clinicians and
supervisors must be able to account for
all charts checked out to them at any
given time, and records are never to be
left unattended in areas with public
access, including exam rooms.
7. Supervising physicians at the clinic
may opt to restrict access to an
individual’s chart by notifying the
Medical Records Supervisor. The
Medical Records Supervisor will make
the necessary changes, and give the chart
‘Restricted’ status. When a chart is
granted restricted access it becomes
exempt from access for research
purposes by students, instructional use,
preview or review discussion, grand
rounds use or access by those not
directly involved in the patient’s
5. Providers and clinicians are entitled
to read a patient’s chart on a ‘need to
know’ basis. Generally this means that
the clinician or attending provider is
currently providing or is scheduled to
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Student Clinician Handbook, 2003-2004
healthcare. A student clinician may not
grant a record restricted status.
Portability and Accountability Act)
policies. The federal government
mandates that these policies be put in
place and adhered to. These policies
will be announced as they are
implemented. All students, staff, and
faculty are required to comply with these
policies as they are implemented.
8. Non-restricted team care records are
still subject to certain limitations.
Patients and their medical care can only
be discussed in a manner that omits any
identifying information about the patient
(i.e. name, specific occupation, address,
identifying relationship or identifying
act). All discussions of medically related
information is restricted to the treatment
room and designated preview-review
areas. Discussion of medical information
in hallways, waiting rooms or other
public areas is strictly prohibited.
CLINIC EMAIL POLICY
GENERAL REGULATIONS:
• Every student and clinic employee
must read and abide by the IT
Acceptable Use Policy (see below).
• No patient identifying data may be
included in any email message.
Examples: name, occupation, DOB,
family member names, status of
relationship to Bastyr community
member, etc.
9. Photocopying patient records—even
for educational purposes—is also
prohibited. Due to the difficulty in
removing or ‘blacking-out’ a patient’s
name or other uniquely identifiable
information, all medical information
taken from a patient’s record for
research, educational purposes, grand
rounds etc. must be handwritten and
contain no identifying information.
Student clinicians and faculty are
responsible for shredding all such
information after use.
STUDENT POLICY:
• Students cannot exchange email with
patients. If a student receives email
from a patient, they must forward the
email to their clinic supervisor for the
supervisor to appropriately respond.
10. Patient contact record sheets must
only list the initials of the patient's name,
and may never contain identifying
information.
BASTYR UNIVERSITY STUDENT
IT ACCEPTABLE USE POLICY
This policy governs the use of email and
other IT systems by students at Bastyr
University.
Confidentiality is of paramount
importance to the safety and well being
of each patient. This is a critical
component of the professional code of
ethics for all health professions.
A. Appropriate Use. Email and other IT
systems may be used only for their
authorized purposes -- that is, to support
the research, education, clinical,
administrative, and other functions of
Bastyr University.
HIPAA POLICIES
Presently, the Bastyr Center for Natural
Health is implementing mandatory
HIPAA (Healthcare Insurance
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Student Clinician Handbook, 2003-2004
B. Specific Proscriptions on Use. The
following categories of use are
inappropriate and prohibited:
1. Use that impedes, interferes with,
impairs, or otherwise causes harm
to the activities of others. Users
must not deny or interfere with or
attempt to deny or interfere with
service to other users in any way,
including by "resource hogging,"
misusing mailing lists, propagating
"chain letters" or virus hoaxes,
"spamming" (spreading email or
postings widely and without good
purpose), or "bombing" (flooding an
individual, group, or system with
numerous or large email messages).
Knowing or reckless distribution of
unwanted mail or other unwanted
messages is prohibited. Sending
email to someone who has requested
that you not do so is prohibited.
Other behavior that may cause
excessive network traffic or
computing load is also prohibited.
2. Sharing of accounts. All Bastyr
University students, faculty, and staff
are provided with accounts with
access rights and privileges that are
appropriate to their specific position
within the University. Do not give
your password and login name to
other people or allow them to access
your account.
3. Misrepresentation of Bastyr
University. Email users shall not
give the impression that they are
speaking for, making statements on
behalf of, or otherwise representing
Bastyr University unless they are
explicitly authorized to do so.
4. Use that is inconsistent with Bastyr
University’s non-profit status. The
79
University is a non-profit, taxexempt organization and, as such, is
subject to specific federal, state, and
local laws regarding sources of
income, political activities, use of
property, and similar matters. As a
result, commercial use of email for
non-Bastyr University purposes is
generally prohibited, except if
specifically authorized and permitted
under University conflict-of-interest,
outside employment, and other
related policies. Prohibited
commercial use does not include
communications and exchange of
data that furthers the University's
educational, administrative, research,
clinical, and other roles, regardless
of whether it has an incidental
financial or other benefit to an
external organization. Use of email
in a way that suggests University
endorsement of any political
candidate or ballot initiative is also
prohibited.
5. Harassing or threatening use. This
category includes, but is not limited
to the display of offensive, sexual
material in the workplace and
repeated unwelcome contacts with
another.
6. Communications with patients or
containing confidential patient
information. While working at the
Bastyr Center for Natural Health
students may not use email to
communicate with patients. If email
is used to communicate with faculty
about a patient, do not include
information that could directly
identify the patient (e.g. name, SS#,
etc.). Email is not a secure channel
of communication and sending
personal information to/about
Student Clinician Handbook, 2003-2004
patients is a violation of HIPAA and
could have serious repercussions for
the student and the University.
7. Use damaging the integrity of
University or other IT Systems.
This category includes, but is not
limited to, the following six
activities:
a. Attempts to defeat system
security. Users must not defeat
or attempt to defeat any IT
system's security -- for example,
by "cracking" or guessing and
applying the identification or
password of another User, or
compromising room locks or
alarm systems. (This provision
does not prohibit, however,
Systems Administrators from
using security scan programs
within the scope of their Systems
Authority.)
b. Unauthorized access or use.
The University recognizes the
importance of preserving the
privacy of Users and data stored
in IT systems. Users must honor
this principle by neither seeking
to obtain unauthorized access to
IT systems, nor permitting or
assisting any others in doing the
same. Users are prohibited from
accessing or attempting to access
data on IT systems that they are
not authorized to access.
Furthermore, Users must not
make or attempt to make any
deliberate, unauthorized changes
to data on an IT system. Users
must not intercept or attempt to
intercept or access data
communications not intended for
that user, for example, by
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"promiscuous" network
monitoring, running network
sniffers, or otherwise tapping
phone or network lines.
c. Disguised use. Users must not
conceal their identity when using
IT systems. Users are prohibited
from masquerading as or
impersonating others or
otherwise using a false identity.
Users are prohibited from
obscuring the true identity of the
sender of an email or forging
email messages.
d. Distributing computer
viruses. Users must not
knowingly distribute or launch
computer viruses, worms, or
other rogue programs.
e. Modification or removal of
data or equipment. Without
specific authorization, Users may
not remove or modify any
University-owned or
administered equipment or data
from IT systems.
f. Use of unauthorized devices.
Without specific authorization,
Users must not physically or
electrically attach any additional
device (such as an external disk,
printer, or video system) to IT
systems.
8. Use in violation of law. Illegal use of IT
systems -- that is, use in violation of civil or
criminal law at the federal, state, or local
levels -- is prohibited. Examples of such uses
are: promoting a pyramid scheme; distributing
illegal obscenity; receiving, transmitting, or
possessing child pornography; infringing
copyrights; making bomb threats; intercepting
Student Clinician Handbook, 2003-2004
electronic communications without proper
authority; and making unlicensed copies of
copyrighted works.
relationships with others. Loss of
privileges, specified disciplinary
requirements or separation from Bastyr
University may be imposed on anyone
whose conduct on or off campus
adversely affects the Bastyr University
community, particularly when it shows
failure to accept responsibility for the
welfare of other persons. Fundamental
kinds of misconduct, which may lead to
suspension or dismissal, are:
With respect to copyright infringement, Users
should be aware that copyright law governs
(among other activities) the copying, display,
and use of software and other works in digital
form (text, sound, images, and other
multimedia). The law permits use of
copyrighted material without authorization
from the copyright holder for some
educational purposes (protecting certain
1. Physical and/or verbal abuse,
classroom practices and "fair use," for
intimidation or harassment of
example), but an educational purpose does not
another person or group.
automatically mean that the use is permitted
2. Racist and/or sexist remarks and/or
without authorization.
behavior towards another person or
group.
9. Use in violation of University contracts. 3. Deliberate or careless endangerment;
All use of IT systems must be consistent with
tampering with safety alarms or
the University's contractual obligations,
equipment; violation of specific
including limitations defined in software and
safety regulations; and failure to
other licensing agreements.
render reasonable cooperation in an
emergency.
4. Obstruction or forcible disruptions of
10. Use in violation of University
regular Bastyr University activities,
policy. Use in violation of other
including teaching, research,
University policies also violates this
administration, clinic services,
AUP. Relevant University policies
discipline, organized events and
include, but are not limited to, those
operation and maintenance of
regarding sexual harassment and racial
facilities.
and ethnic harassment.
5. Interference with the free speech and
movement of any academic and/or
11.
Use in violation of external data
community members.
network policies. Users must observe all
6. Dishonesty, including provision of
applicable policies of external data networks
false information, alteration or
when using such networks.
misuse of documents, plagiarism and
other academic cheating,
PROFESSIONAL CONDUCT
impersonation, misrepresentation or
This is the Code of Conduct for all
fraud.
members of the Bastyr University
7. Theft, abuse or unauthorized use of
community. Please see Student
personal or Bastyr University
Handbook and clinical faculty
property.
Handbook.
8. Use of illicit drugs or being on the
premises in a drug or alcohol The rights and privileges exercised by
intoxicated state.
any person are always a function of their
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Student Clinician Handbook, 2003-2004
4. The Natural Health Care Practitioner
shall recognize, respect and promote
the healing power of nature inherent
in each human being.
Student/Professional Code of Ethics:
While in the Bastyr Center for Natural
Health, Bastyr University Externship
site, or an approved Preceptorship, the
intern clinician’s scope of practice is
limited to the scope of practice of that
shift. An intern clinician may not
exceed the scope of practice of the
supervising clinician or the scope of
practice of the shift in which the care is
provided.
5. The Natural Health Care Practitioner
shall strive to identify and remove
the causes of illness, rather than to
merely eliminate or suppress
symptoms.
6. The Natural Health Care Practitioner
shall educate her/his patients, inspire
rational hope and encourage selfresponsibility for health.
CODE OF ETHICS
Introduction
The purpose of the Bastyr Center for
Natural Health Code of Ethics is to
provide a framework within which all
students and staff at the Bastyr Center
for Natural Health can learn and work in
a safe, nurturing and supportive
environment. Ethical behavior is critical
to the quality of interactions among
individuals and groups within the
University and Clinic. They also reflect
on the quality of health care given to the
patients at the Clinic. We are all striving
for excellence, as individuals, and as an
institution, and this Code of Ethics gives
us guidance in seeking that excellence.
7. The Natural Health Care Practitioner
shall treat each person by
considering all individual health
factors and influences.
8. The Natural Health Care Practitioner
shall promote personal well-being
and the prevention of disease for the
individual, the community, and our
world.
9. The Natural Health Care Practitioner
shall acknowledge the worth and
dignity of every person.
1. The Natural Health Care
Practitioner’s primary purpose is to
restore, maintain and optimize health
in human beings.
10. The Natural Health Care Practitioner
shall safeguard the patient’s right to
privacy and only disclose
confidential information when either
authorized by the patient or
mandated by law.
2. The Natural Health Care Practitioner
acts to restore, maintain, and
optimize health by providing
individualized care, according to
his/her ability and judgment.
11. The Natural Health Care Practitioner
shall act judiciously to protect the
patient and the public when health
care quality and safety are adversely
affected by incompetent or unethical
practice by any person.
3. The Natural Health Care Practitioner
shall endeavor to first, do no harm
and to provide the most effective
health care available with the least
risk to his/her patients at all times.
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Student Clinician Handbook, 2003-2004
12. The Natural Health Care
Practitioner shall maintain
competence in her/his field and
strive for professional excellence
through assessment of personal
strengths, limitations and
effectiveness and by advancement of
professional knowledge.
the clinic and not dressed
professionally, please make a point
of not lingering where patients are
present.
2. The dress code requires clean, neatly
pressed clothing, in good condition,
presenting a professional attitude
about the role that you are
performing. Clothes should be
dressy rather than casual and not
revealing. Open-toed sandals or
shoes are not permitted in the clinic,
in compliance with Department of
Health regulations.
13. The Natural Health Care
Practitioner shall conduct his/her
practice and professional activities
with honesty, integrity and
responsibility for individual
judgments and actions.
14. The Natural Health Care
Practitioner shall respect all ethical,
qualified health care practitioners
and cooperate with other health
professionals to promote health for
the individual, the public and the
global community.
3. Clothing considered too casual for
the clinic includes denim material of
any color, jeans style pants, athletic
footwear, slipper-type footwear,
deck shoes without socks, T-shirts,
polo shirts, tank tops, spaghetti strap
sundresses and shirts, sweat shirts,
sweat pants, and shorts.
Undergarments should not show
through clothing. If belt loops are
present, a belt or suspenders are
required.
15. The Natural Health Care
Practitioner shall strive to exemplify
personal well-being, ethical character
and trustworthiness as a health care
professional.
4. Men are required to wear a shirt and
tie unless they are wearing
appropriate apparel that does not
require a tie. The only allowable
exceptions to a shirt and tie are
turtleneck sweaters, mandarin
collared dress shirts, collarless dress
shirts designed to be worn without a
tie, medical smocks or surgical
scrubs (Physical Medicine shifts
only).
(Adapted from the American
Association of
Naturopathic Physicians Code of
Ethics)
CLINIC GUIDELINES FOR DRESS,
HYGIENE AND GENERAL
APPEARANCE
1. The purpose of the dress code is to
help develop and convey a sense of
professionalism and to support an
attitude of respect toward patients,
the clinic and our medicine. All
medical and clinic staff, and students
working when the clinic is open need
to comply with the dress code. If
one is not on duty, but stopping by
5. Women are required to wear an
appropriate top (sweater, blouse,
shirt) and bottom (dress slacks,
pants, skirts, dressy culottes, or
dresses). Skirts, dresses and culottes
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Student Clinician Handbook, 2003-2004
must be of modest length. Clothing
should never be tight fitting or
revealing. An appropriate top of
modest length must cover tights and
leggings.
Technique Standards. Please review
these guidelines, which are located in
the Lab. In addition, OSHAmandated education will be required
annually in regard to Blood Borne
Pathogens. The Health and Safety
Officer will inform you of the
requirements and provide
opportunities for compliance.
6. Medical smocks/surgical scrubs are
allowable during Physical Medicine
shifts.
7. All clinicians in the acupuncture
department must wear a white lab
coat of knee length with lapels over
their clothing. This coat must be
clean and pressed at all times. The
student is responsible for his or her
own lab coat and its care (washing
and pressing). It is not permissible
to borrow another clinician’s lab coat
without the owner’s permission.
12. Photo ID badges are required while
on duty in the clinic. You will not be
allowed in the clinic if you are not
wearing your photo ID badge. The
dress code must be followed when
representing the Bastyr Center for
Natural Health or Bastyr University
at external sites or events. Photo ID
badges should be ordered in clinic
entry class.
8. All Interns must be dressed
appropriately for the duration of their
entire shift, including preview and
review.
13. No foods or beverages are to be
consumed in the exam rooms. The
exam rooms should be kept free of
personal items as much as possible.
9. It is preferable that clinicians have
no visible piercings or tattoos.
However if they do, they must be
minimal and tasteful. Many patients
may find them offensive. Please be
aware of this.
It is up to each individual to follow this
code. It is uncomfortable and
unnecessary for others in clinic to have
to remind individuals of the dress code.
The clinical faculty and Medical
Director will deal with continued and/or
flagrant disrespect for each other and for
patients by not following this dress code
on a case-by-case basis. Violations of
the dress code may result in the
following:
10. Please be aware of breath and body
odors when at the clinic. Please do
not wear strong smelling scents, or
perfumes in the clinic. Keep hair,
beard, and fingernails clean and
neatly trimmed. Tie or pin back long
hair. Hair should not be shocking or
outrageous in style or color.

11. Everyone in the clinic is required to
follow the guidelines for Universal
Precautions for Infectious Diseases,
Safety Standards, and Sterile
84
For the first offense the student
will get a written warning. Any
clinical faculty supervisor can
write this warning to a student. A
copy of this warning will be
given to the student’s supervisor
if a different supervisor wrote it.
Student Clinician Handbook, 2003-2004

For the second offense, the
student will be sent home for the
shift, and the student will be
issued a sanction. The student
will lose all hours and patient
contacts for that day’s shift.

For the third offense, the student
will be sent home for the quarter,
fail the shift, and the entire shift
will need to be made up.
chest radiograph. There are no waivers
of this policy. Employees who do not
comply with this policy will be
prohibited from working at the clinic.
Students who do not comply will not be
allowed to take clinic shifts, or register
for clinic shifts.
Bastyr University agrees to pay for:
100% of the cost of tuberculosis
screening for all staff and Clinical
Faculty, per OSHA/WISHA regulations.
50% of the cost of tuberculosis screening
for students, including 50% of chest xray if required. (up to one half of the
amount charged by the King County
Department of Health).
Students are required to return all
documentation to the registrar’s office at
the university.
Clinic staff must return documentation
to the Clinic Safety Officer.
IMMUNIZATION POLICY
PURPOSE
To protect the health and safety of
employees and students who may be
exposed to certain biohazard agents in
the campus and clinic-working
environment.
TB SCREENING
All clinical faculty, students and staff
who work or take shifts in the BCNH or
at an external shift site are required to be
tested for TB annually. If vaccinated,
students must provide proof of
vaccination and provide documentation
to the Safety Officer. The BCG Vaccine
is not proven protection against TB.
People who have had a BCG vaccine
and have no record of ever having a
Mantoux PPD TB test are required to
have a Mantoux PPD skin test if it is a
requirement for school or work. If
anyone refuses to have a Mantoux PPD
skin test, they are required to get a chest
x-ray. If anyone has a positive Mantoux
PPD skin test, they are required to get an
annual chest x-ray.
HEPATITIS B IMMUNIZATIONS
The following occupational positions
and student clinicians have been
designated as “exposed individuals” and
are required to either take the Hepatitis
B immunization series, provide
documentation that they have had such
immunizations in the past ten (10) years,
or sign a waiver refusing the
immunizations, along with a release of
liability form:
• All ND and AOM students and
clinical faculty
• All clinic laboratory and operation
staff
• All employees at the main campus
in the following capacities: instructor
of any class, first aid officer, or any
other person whose job may
include tasks involving possible
exposure to body fluids/tissues
If positive TB test occurs without proof
of prior immunization, students must
provide documentation of appropriate
medically supervised post-test followup. This follow-up is inclusive of a
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Student Clinician Handbook, 2003-2004
NOTE: It is not the University’s
position to deny anyone from being
immunized. Each person has the
opportunity to provide for his or her own
immunization. If an employee believes
that he/she is at risk, but is not on the list
of at-risk personnel s/he can appeal that
decision to the Campus Safety Officer.
HANDWASHING AND
DISINFECTION
All students and supervisors are required
to wash hands with soap and warm water
before and after every patient visit.
Disinfection of surfaces (exam tables,
sink and countertop, lamp, etc.) must be
performed between each patient visit.
Refer to infection control manual located
in lab for details.
Bastyr University agrees to pay for:
100% of the cost of the immunization
series for all staff and clinical faculty,
per OSHA/WISHA regulations.
50% of the cost of the immunization
series for students (up to one half of the
amount charged by the King County
Department of Health).
ND AND AOM CLEAN NEEDLE
TECHNIQUE AND BIOHAZARD
WASTE HANDLING
You are responsible for knowing the
OSHA guidelines for blood borne
pathogens. You are required to view a
training video and sign a document
acknowledging that you understand
these guidelines annually. Please follow
the clinic policies for handling biohazard
materials by placing disposables in the
biohazard bags located in each exam
room. Reusable instruments should be
taken immediately to the supply room
for cleaning and sterilization. Biohazard
materials include all supplies and
instruments that have come into contact
with patient body fluids, such as blood,
urine, vaginal secretions, saliva, etc. See
the Safety Manual in the laboratory or
ask the current infection control
representative for details.
ALL OTHER REQUIRED
IMMUNIZATIONS
For external clinic shifts or preceptor
sites which require MMR immunization
(measles, mumps, and rubella) or any
other kind of immunization or proof of
immunity:
The student is required to pay for:
All costs involved in testing for antibody
levels, if they choose to check for
immunity, as well as costs for
immunizations.
The waiver, commencement of the
immunization series, and tuberculosis
screening shall occur before the first day
of work for all clinical faculty and staff
and before ND and AOM students enter
the clinic, and with the start of Fall
Quarter each year for entering ND and
AOM students. Screenings shall occur
at the campus and clinic. However, the
student may need to receive certain
immunizations and screenings off-site on
occasion.
ACUPUNCTURE NEEDLE POLICY
1. An acupuncture needle count will
be made prior to any treatment and
initialed by the intern before
insertion. Any needles added or
removed during the treatment must
be recorded. After removal of all
needles a final count must be made
and initialed by the intern(s) and
by the supervisor. This
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Student Clinician Handbook, 2003-2004
information must be recorded on
the chart notes for every visit.
2.
Any lost needle must be brought to
the attention of the supervisor. A
continued lost needle will result in
a flagged garbage to be deposited
in the blood borne pathogens
“box” and laundry from the room
will be flagged. A special notice
will be placed on the door alerting
the janitorial crew to the lost
needle in the room. On rare
occurrences it is possible a patient
will take a needle home that
dropped into a pants cuff or
elsewhere in clothing. A decision
may be made to call a patient and
alert them to this possibility.
3.
“Lost needle” incidents will be
recorded by the supervisor and
brought to the attention of the
Clinic Program Coordinator
immediately. The Clinic Program
Coordinator will record the
incident and send a copy to the
Clinic registration staff to be
placed in the student’s record.
Any pattern of continual
occurrences of lost needles will
result in clinical sanctions. If the
needle is found related to a
specific room or shift this could
result in clinical sanctions for the
clinicians in that room.
4.
All practitioner care acupuncturists
working out of the Bastyr Center
for Natural Health will be alerted
to this policy and the clinic’s
concern. If needles are found the
Clinic Medical Director must be
notified so proper feedback may
be initiated.
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Student Clinician Handbook, 2003-2004
PATIENT VISIT PROCEDURE
Supervising (Attending) Clinical
Faculty
The supervisor must personally see each
patient, in the exam room, and
participate directly in gathering key
subjective information from the patient
and performing key physical exams on
the patient at the appropriate time during
each clinic visit.
d.
The supervisor must also participate
actively in discussing and making the
diagnosis(es) and must direct the
treatment plans for each patient. The
supervising (attending) clinical faculty is
responsible for both the quality of care
provided to each patient and the quality
of supervision given to the student
clinicians. Overall case management is
the responsibility of the supervising
clinical faculty. Specifically, the
supervising clinical faculty is
responsible for the following:
e.
f.
a. Preview each case with the
students during case preview in
order to establish a framework
from which the students can
proceed. Please follow case
preview guidelines.
b. Teach the students how to
proceed through the standard
SOAP format in case taking and
management.
c. Actively participate in and
approve a diagnostic strategy,
being certain that the assessment
is established before the plan is
discussed and/or implemented.
The primary student clinician
should present a differential
diagnosis to the supervisor with
reasons to support and/or rule out
each differential diagnosis. The
g.
h.
88
supervising clinical faculty
makes the final decision on all
aspects of case management.
Decide whether or how much of
the case discussion should take
place in front of the patient or in
a private area. When the
supervising clinical faculty is
discussing the case with the
student clinicians outside the
patient’s room, be as timely as
possible and don’t leave the
patient alone for an unreasonable
amount of time.
See to it that appropriate referrals
take place, either in-house or to
an outside doctor or facility.
There is a referral directory in the
clinical faculty office with a
comprehensive listing of
referrals. There is also a referral
protocol that student clinicians
and supervising clinical aculty
should follow.
Actively participate in
formulating and then approve the
plan of treatment, be sure the
patient plan and instruction
sheets given to the patient are
accurately filled out, code the
superbill, and sign or initial other
appropriate forms such as the
dispensary order form, lab
requisition form and/or record
release form.
See to it that “Scheduling
Instructions”/patient follow-up
appointment cards are completed
for each patient, to inform patient
of their follow-up
appointment(s).
Go door to door 15 minutes
before case review and insure
that student clinicians are
progressing towards completion
of the visit.
Student Clinician Handbook, 2003-2004
Approve and/or amend case notes and
sign them once the chart is completed
and signed by the student clinician. All
AOM chart notes must be completed and
signed at the end of the shift during
which the treatment took place. ND and
Nutrition charts must be signed within
72 hours of visit.
i. In order to demonstrate
supervisor faculty involvement in
each patient visit, each
supervising faculty must
complete a “Supervising Faculty
Comments/summary Statements”
section at the end of the progress
notes for each visit.
j. It must be obvious to any chart
reviewer that the supervising
faculty has done each of the
following:
1. Met each patient and
confirmed aspects of the
history
2. Observed and/or repeated
any important positive or
negative physical exam
findings
3. Confirmed the given
diagnoses and assessments
4. Guided and approved all
treatments and follow-up
recommendations
k. The summary must contain the
supervising faculty’s comments
on the charted subjective,
objective, assessment and
treatment portions of the visit.
The supervisor comments must
indicate active involvement on
the part of the supervisor and
should include some content and
brief analysis of each section (S,
O, A, and P) of the chart notes.
The use of “I repeated…”, “I
observed…”, “I questioned…”,
“I prescribed…”, “I
l.
m.
n.
o.
p.
q.
r.
s.
t.
89
instructed…”, “I believe…”, are
useful indicators of supervisor
involvement.
Initial the patient summary line
on the inside cover of the chart
for each date that a patient is
seen.
Indicate the approved number of
refills for any dispensary items
on the dispensary order form.
Make sure the superbill is filled
out completely: patient name
(last name in capital letters),
date, circle appropriate visit
code, diagnosis and diagnostic
or procedure lab tests, and initial
it.
Attend and direct case review at
the end of the shift as explained
in the “Guidelines for student
clinician-Clinic Doctors General
clinic interaction.”
Initial the student’s summary of
patient contact form and time
sheet when it is completed by
the student at the end of the
shift. This must be done daily.
Delegate responsibility to the
primary student clinician as
soon and as much as possible
based on competence and
evaluations.
Give appropriate feedback to
students each week regarding
their case management, using
the student daily evaluation
form as a guideline. It is
strongly encouraged to give
each primary student weekly
written evaluations.
Take attendance on each shift.
Supervisor must be present in
the exam room during all
male/female genital exams or
treatments that expose these
areas. Supervisor must ensure
Student Clinician Handbook, 2003-2004
u.
v.
accuracy of all abnormal
physical exam findings.
Supervisor must take an active
role in communicating difficult
or potentially life-threatening
news to a patient and should not
delegate this task to student
clinicians.
Patients are to remain under the
care of the supervisor from
quarter to quarter rather than
follow the students. In rare
cases, exceptions may be made
by the supervisor.
late patient. If a patient arrives
more than 20 minutes late for
their appointment, the
receptionist will page the
supervisor. The supervisor will
determine the viability of
starting the appointment or the
need to reschedule the
appointment.
c. Meets the patient in the
reception area and shows the
patient to the exam room.
She/he should explain to a new
patient how our clinic operates
and how patient visits are
conducted, and tell the patient
how many supervisors and/or
observers will be attending the
visit. (From this point onward,
the patient is not to be left
unattended, except for the
purpose of providing privacy
during disrobing and dressing
again in connection with a
physical exam, or when the
student clinicians and supervisor
discuss the case in private
consultation.) Make sure to tell
all patients to wait until the
clinician returns before getting
up onto the exam/massage table.
Additionally, do not leave
patients with limited physical or
mental capacities unattended for
more than brief periods of time.
d. Takes case notes in black pen
only, neatly and in an organized
manner, following the standard
SOAP formats. An S, O, A or P
should be written in for each
appropriate section on the
Progress Form.
e. Carries out supervisor’s
instructions with respect to
interviewing the patient,
performing a physical exam,
AOM/ND/Nutrition Primary/Intern
Student Clinician
The primary student intern is responsible
for presenting her/his cases in case
preview and review, directing patient
interview, taking the case notes and
assessing the patient both subjectively
and objectively. After collecting this
information, the student meets with the
supervising faculty to discuss the
diagnostic strategy and, once a diagnosis
is reached, establish the plan. The
primary student intern is encouraged to
think through and develop her/his own
strategy and management of the case.
The supervising clinical faculty makes
the final decisions and is responsible for
all aspects of case management.
Specifically, the primary student intern:
a. Previews the case with the
attending clinical faculty
member and secondary student
clinician during case preview
before initiating contact with the
patient.
b. It is the responsibility of the
primary intern to physically
check the reception area for the
first 15 minutes of a scheduled
appointment in the event of a
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Student Clinician Handbook, 2003-2004
f.
g.
h.
i.
diagnostic studies, and making
referrals and treatment plans.
Familiarizes the secondary
student clinician with her/his
style of case management, and
directs/supports the secondary
student clinician’s role as an
observer and facilitator.
Signs the chart when it is
completed, fills in the summary
of patient contact Health Data
and Medication List forms on
the inside cover of the chart,
makes certain that the superbill
is completed correctly and
obtains the supervisor’s
signature on the case notes.
Is responsible for recommending
that the patient is rescheduled at
a time that the supervisor and, if
possible, the primary and/or
secondary student clinicians are
present. The supervisor, with
the knowledge and consent of
the patient must approve
exceptions.
Is responsible for follow-up
telephone contact with the
patient, with supervisor
approval, and phoning the
patient when there is a
cancellation or no-show on a
scheduled visit, with the goal of
finding out why the patient was
unable to come in, the state of
their health and to reschedule an
appointment. Limit the length
of all phone calls to/from
patients to no more than 3
minutes. All phone contacts
need to be pre-approved by the
supervising clinical faculty. Be
certain to record any phone
contact information in the
patient chart, and have it signed
by the supervising clinical
j.
k.
l.
m.
faculty. (Patients appreciate
your personal care and the
interest you show in their health
care.)
At the end of the shift, is
responsible for having the time
sheet and summary of patient
contacts signed off by the
supervisor/clinical faculty.
Properly drape patients and pull
blinds when patients are asked
to gown-up.
Become familiar with clinic
resources, such as patient
protocols, therapeutic
notebooks, forms, etc.
Only practice modalities in
which coursework has been
completed, and which your
supervisor has approved (i.e.,
utilizing cranial sacral therapy
should only occur on shifts
when the supervisor is also
proficient).
AOM/ND/Nutrition
Secondary/Observer Student
Clinician
The secondary student clinician has an
observer/facilitator role. It is her/his
responsibility to discuss with the
primary student intern on each shift
exactly what role she/he is to take during
the patient visit. Specifically, the
secondary student clinician:
a. Becomes familiar with each case
on each shift before case preview.
b. Makes certain that the exam room
is in order and that all the necessary
supplies are in the room. There is a
list of supplies for each room in the
cabinet above the sink. Insures that
the paging telephone volume is at
an audible level.
c. Attends case preview to provide
input on each case with the primary
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Student Clinician Handbook, 2003-2004
d.
e.
f.
g.
h.
i.
j.
k.
l. Personally takes the patient’s chart
to the reception desk of a different
department if the patient is
subsequently scheduled for a visit
in that department.
m. No treatment modality may be
applied to the patient, or patient
instruction given to the patient
without the prior approval of the
supervisor.
student intern and supervising
clinical faculty.
Oversees the dispensary care,
entering all dispensary items on the
prescription form. She/he then
obtains supervisor’s signature on
the form, seeing that the date, item
and refill section are complete.
This student also takes the form to
the appropriate dispensary.
At the conclusion of the office
visit, accompanies the patient to the
front desk to have the return office
visit scheduled, and check out. The
student does not need to wait with
the patient.
Instructs the patient that they will
have to obtain and pay for their
dispensary items separately from
the visit fees. The student should
also direct the patient to the
dispensary.
Makes certain that the room is
cleaned and ready for use on the
next shift.
Attends case review during the last
half-hour of the shift.
At the end of the shift, is
responsible for having the time
sheet and summary of patient
contacts signed off by the
supervising acupuncturist/clinical
faculty.
Anticipates the paper work that
will be needed on a shift and have
it ready: release of records, diet
diary, clinic referral form, etc.
Completes all information on the
Records Release Form, has patient
sign and date the form, and when
complete obtains supervisor’s
initials before copying for chart and
forwarding to Medical Records.
Notes the name of the requesting
primary intern on the form.
Time Management
a. Student clinicians are responsible
for beginning and ending patient
visits on time.
b. A regular FOC is 1.5 hours, of
which 1.25 hours is for the patient
visit and 15 minutes is for
completing the chart and preparing
for the next patient. You should
manage your time appropriately.
Homeopathy FOC’s are 2 hours.
Nutrition FOC’s are 1 hour.
c. An acute FOC is 1 hour, of which
45 minutes is for the patient visit,
and 15 minutes is for completing
the chart and preparing for the
next patient.
d. A regular ROC is 1 hour, of which
45 minutes is for the patient visit
and 15 minutes is for completing
the chart and preparing for the
next patient.
e. An acute ROC is for 30 minutes,
of which 20 minutes is for the
patient visit with 10 minutes used
for completing the chart. The
purpose of this visit is for followup on one acute health concern.
f. “Introduction Visit” is for 20
minutes. The purpose of this visit
is to answer patient questions and
provide general information. No
diagnosis or treatment is given.
g. As each patient visit is completed,
the exam room is to be disinfected,
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Student Clinician Handbook, 2003-2004
h.
i.
organized, and made ready for the
next patient.
Time should be managed so that
the student clinicians are done and
are ready for case review for the
last 30 minutes of the shift.
Students cannot determine the
length of a visit. This is the
responsibility of the supervising
doctor. When a patient schedules
and is seen for a visit, the length of
the visit should not be changed
without the supervisor’s consent.
b.
Patient Requests That Student
Clinicians Not Be Present for Portions
of Office Call
When a patient initiates a request that
student clinicians not be present for
portions of the office call, it is
appropriate for the attending physician
to honor the request and facilitate
meeting it. We must assume that the
patient has a legitimate reason for
making this request.
c.
d.
If the request was made to the student
clinician, it is acceptable for the
supervisor to clarify this request with the
patient.
staff the completed superbill. The
supervisor is responsible for filling
out the superbill accurately and
completely, with all diagnostic, E
and M, and procedure codes as
appropriate. Students should not
linger at the front desk and only
wait there if assistance is required
for patients with a special
scheduling need. No information
regarding diagnosis or treatment,
other than that needed to schedule
an appointment, is to be discussed
outside of the exam room.
All patients must check out at the
front desk before leaving the
clinic. Secondary clinicians are
responsible for notifying the front
desk of any late patient checkouts.
The patient services department,
prior to the patient visit, must
arrange all payment arrangements,
or discounts on services. Students
must not discuss fees or payment
arrangements with patients.
Be familiar with the scope of
clinic services.
PATIENT RECORDS AND
RELATED FORMS
Following is a list of forms that you
should become familiar with and use in
the clinic. If you have questions about
these forms, please contact the Clinic
registration staff or Clinic Program
Coordinator:
1. Comprehensive FOC Case
History Interview Form
2. Progress Notes Form
3. Physical Exam Form
4. Patient Summary Form in Chart
5. Medication Log form
6. Patient Information Form
7. Adult Health Data Form
8. Pediatric Health Data Form
However, it is not appropriate for staff,
students, or faculty to initiate or
encourage any patient to ask for changes
from the assigned schedule or for a
different clinician arrangement.
Check-out with Payment for Services
a. When the patient visit is
completed, the primary or
secondary student clinician must
accompany the patient to the front
desk for rescheduling and checkout. Be sure to hand the front desk
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Student Clinician Handbook, 2003-2004
9. Dispensary Order Form
10. Lab Requisition Forms (InHouse and Reference Lab)
11. Patient Plans and Instructions
Form
12. Summary of Patient Contacts
Form
13. Reportable Disease Form
14. Preceptor Program Forms
15. Interim Hour Form
16. Substitute/Absence Form
17. Advising Form
18. Clinical Faculty/Clinical Faculty
Evaluation Scantron Card/Form
19. Referral Letter Samples
20. Request for Patient Records
Form
21. Diet Diary Form
22. Student Report to Medical
Director Form
23. Patient Profile Form
24. Consultation Interview Form
25. Time Sheets
26. Life Contract
27. Naturopathic Welcome
Information
28. Observation Consent Form
29. Informed Consent 1 and 2
30. New Patient Information Form
31. Naturopathic Treatment of
Malignancy
32. Interpreter guidelines
33. Ossious manipulation screening
questionnaire
34. Referral forms (templates)
removed from the files. Place the charts
in the chart return box, if completed and
signed, and the front desk staff will refile
them. If incomplete or needing
supervisor signatures, complete a Patient
Chart Requires Action notice and place
this notice in the supervisors mailbox.
The incomplete chart must be returned to
the chart room while it is not being used
or completed by the clinician. Attach an
‘incomplete’ chart tag inside the front
cover and place in supervisors chart box.
All AOM charts must be completed by
the end of the shift on which the patient
was seen. All other charts must be
completed within 24 hours of the
contact. AOM supervisors must sign all
charts at the time of service. All other
supervisors must signcharts within
another 48 hours. Please refer to the
guidelines around front desk function
and student’s responsibilities when
interacting with the front desk. (See
chart guidelines at front desk for more
information.)
2. If a student clinician removes a chart
that contains any patient identifying
information from the Bastyr Center for
Natural Health premises:
a. On first offense, it will result in a
failure in clinic for one entire quarter
shift, including loss of hours and
patient contacts.
b. On second offense, it will result in a
second clinic shift failure and
immediate clinic suspension.
PATIENT CHARTS
PATIENT CHARTS ARE TO REMAIN IN
THE CLINIC AT ALL TIMES. UNDER
NO CIRCUMSTANCES ARE PATIENT
CHARTS EVER TO LEAVE THE CLINIC.
3. There are several basic chart
components to each patient’s chart, (and
correct placement in chart):
1. When a chart is removed from the
front desk area, an out card must be
filled out and put in the chart’s place.
Do not re-file charts that have been
a.
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Patient in-take form (last page on
inside front cover)
Student Clinician Handbook, 2003-2004
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Case history/physical
exam/assessment/plan forms (filed
in chronological order, most recent
on top)
Progress notes (filed in
chronological order)
Copy of Plans and Instructions
(ND) to patients (filed with notes
from that day’s visit)
Lab reports (back section, on left)
Previous medical records and
copies of release forms (back
section on right)
Patient Summary Sheet (first page
on inside front cover)
Adult or Pediatric Health Data
Form (inside front cover)
Statement and Insurance Form
(superbill - placed inside of chart
prior to each visit)
Patient information form (inside
left front cover directly beneath
medication log form)
Medication Log form (inside left
front cover, on top of Patient
information form)
Referral form (when current, it
supercedes all other forms on top
of inside front cover)
b.
c.
d.
e.
f.
g.
h.
i.
4. Each component of the chart is the
responsibility of one or more members
of the patient-care team: supervising
physician/clinical faculty, primary
student clinician, secondary student
clinician. The responsibility of keeping
the charts in order belongs to the
primary student clinician:
a. The patient summary sheet will be
fixed as the first page on the left
inside cover of the chart. The
sheet will contain an entry for each
visit that should be filled out
correctly and initialed by the
supervising physician/clinical
faculty.
j.
k.
l.
95
Lab reports are to be 2-hole
punched at the top and inserted
into the back section of the chart,
on the left.
The patient intake form will be 2hole punched at the top and
inserted as the last page in the
front section of the chart under the
patient summary sheet.
The FOC forms will be 2-hole
punched at the top and inserted in
the front section of the chart,
opposite the intake form.
The Adult Health Data form will
be 2-hole punched and placed
inside left cover.
The Patient Information form will
be 2-hole punched and placed
inside left cover.
The Medication form will be 2hole punched and placed on top of
the Patient information form.
Progress notes for each succeeding
ROC will be 2-hole punched at the
top and inserted on top of the
previous visit notes.
Previous medical records should
be 2-hole punched at the top and
inserted in the back section of the
chart opposite the lab reports in
order received.
Notes/letters from referral
physicians should be 2-hole
punched at the top and inserted as
they are received as previous
medical records and behind FOC
forms.
Referral letter when current; it
supersedes all other forms on top
of inside front cover.
All charts must be completed by
the primary student clinician in 24
hours and signed by the
supervising physician within 72
hours after the patient contact.
Student Clinician Handbook, 2003-2004
5.
Where the frequency was mixed, both
frequencies should be noted.
Charting concerns and/or deficits
identified should be discussed by
the supervising physician/clinical
faculty and student, and corrected
immediately. If this doesn’t
resolve the problem, the student
will be warned in writing of the
problem and asked to correct it
within a defined time limit. If chart
is not corrected within that time,
the student will receive a clinic
sanction.
4. When moxibustion is used, the
location, type of moxibustion and
duration should be noted.
5. When cupping is part of the treatment,
the location of the cupping and whether
walking cups were used should be noted.
6. When acupressure is used, the
location and type of procedure should be
noted.
CHARTING GUIDELINES
7. Any additional procedure, such as tui
na, or gau sa, must be charted in the plan
section of the chart notes.
AOM CLINIC
1. Each treatment episode is charted in
the form of “SOAP” notes.
a.
b.
c.
d.
8. No mark or designation reflecting the
nature of the diagnosis may appear on
the outside of the chart.
S: Subjective findings, the chief
complaint and history portion of
the treatment episode.
O: Objective findings, the
observation of tongue and pulse,
as well as other observation,
orthopedic tests and palpation
A: Assessment, the diagnosis,
change in status, or other
conclusions.
P: Plan, treatment principle,
acupuncture prescription, herbal
formulas, other modalities used,
referrals made to other providers
and patient instructions
2. All acupuncture prescriptions should
include points needled, type of needles
used and any special technique.
3. When electro-stimulation is provided,
the chart notes should include which
points were stimulated in the format of
from point A to point B, what mode was
used [continuous, discontinuous, mixed],
what frequency was used in Hertz.
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Student Clinician Handbook, 2003-2004
b.
ND CLINIC
1. All chart entries must be make in
black ink on the appropriate form [see
Progress Notes, Appendix 5]. Do not
use ink colors other than black. Do not
use pencils or erasable ink.
Computerized chart notes must be done
on clinic read-only templates installed
on clinic library computers. Charting
may not be done on personal computers
or PDA’s. This policy is to protect the
confidentiality of our patients.
SOAP FORMAT
Case Taking and Charting
Note that within the SOAP format there
are variable styles of charting.
1. Each chart should have a subjective
(S), Objective (O), Assessment (A)
including therapeutic order, Plan (P),
Future Plan (FP) and Impression (I).
2. All charting corrections or changes
made by a student or supervising faculty
in a chart on the day of the original entry
are to be made as follows:
a.
b.
c.
d.
2. The primary student clinician is
responsible for signing the chart
before giving it to the supervising
clinical faculty for review and
signature. Each chart should be
returned to the chart room and a
chart review form placed in the
supervisor's clinic mailbox to alert
them to the need for review and
signature of the chart. (Note that
within the SOAP format there are
variable styles of charting.)
Draw one line through the entry to
be changed.
Write the new entry next to the old
entry.
Initial the change.
Please refer to the Medical
Abbreviations list in the Appendix
for approved medical
abbreviations in charting.
3. Charts need to be clear and concise.
The S, O, A, etc., need to be clearly
written out in legible writing. A new
CC should have all 7 attributes, as
appropriate. Old complaints need
documentation of what has changed
or is different. At each visit, the
student should ask what
medications/supplements patients are
taking or if they are taking what has
previously been prescribed. If a
patient discontinues a
medication/supplement, is should be
noted in the medication/supplement
sheet on the left of the chart.
3. For all chart changes made in a chart
after the day of the original entry by the
supervising faculty:
a.
b.
c.
d.
A completed patient intake form
and patient billing/insurance form
Draw one line through the entry to
be changed.
Write the new entry next to the old
entry.
Initial and date the change.
No changes can be made after the
provider has signed the chart.
4. No patient may be treated without the
following:
4. Spelling should be accurate.
a.
A 'consent to treatment' form
signed by the patient of the
patients designated signatory.
5. All paperwork must be filled out in
its entirety before turning in the chart
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Student Clinician Handbook, 2003-2004
to the supervisor for their signature.
This includes the chart notes with the
patients name, date, supervisors full
name and your full name on every
page, treatment plan for patient,
patient visit summary, with correct
ICD-9 code/s,
medication/supplement sheet filled
out completely with dosing schedule
and ordering doctor, even if it is self
prescribed, adult health data sheet or
pediatric health data sheet with
patients data, their PCP or specialists
with addresses, phone numbers and
drug allergies. Treatment plans in
the chart must include dose in terms
of mg/grams/etc., not just 3 caps
TID, unless it is a multivitamin or
combination product, and also a brief
rationale of why the student has
chosen those specific therapeutics.
9. Assessment: The Assessment is
perhaps the most important part of
the chart. Assessment may be as
simple as stating the Diagnosis(es),
when the clinician is certain of the
patient’s specific disease entity. You
may consider your diagnosis likely
but not certain, in which case you
should precede the stated diagnosis
with an indicative term such as
“working” diagnosis, “presumptive”
or “probable” diagnosis. In this
event, your Assessment will also
include Rule/Out(s) or a Differential
Diagnosis, for example: “Probable
Diagnosis: Atypical Migraine
Headache, Rule/Out increased intraocular pressure.” To the extent that
you know it, record your diagnostic
rationale after each Diagnosis or
tentative Diagnosis. All active
diagnoses that are addressed in any
way at a given encounter, with a
correct ICD-9 code for each, must be
recorded in the Assessment section,
corresponding exactly with the
correct diagnoses that are recorded
on the superbill. This account will
be brief when charting the evaluation
and management of an independent,
self-limited, acute problem, and
complex when managing a complex
encounter. Remember that every
stated Rule/Out or Diagnosis
requires a corresponding action in
the Plan for that day intended to
accomplish the Rule/Out or address
the Diagnosis (even if the action is
only to watch and wait), whereas
Differential Diagnoses may have but
do not demand an action that
addresses them in that day’s Plan.
Finally, all active or resolved
Diagnoses and Problems are
recorded and tracked on the patient’s
Health Data Sheet, which appears on
6. Do not leave any preparation notes in
the chart. If the student has done
preparatory work, the student must
keep that information.
7. All of the documentation must be
completed within the borders of the
chart. Anything outside of those
borders, i.e. the dark thick line, may
not be copied when medical records
are requested from another provider.
This includes S, O, etc., and
signatures.
8. Charts must be completed and signed
by the student within 24 hours after
the visit. Once the chart is
completed, the student must fill out a
chart action review form for their
supervising faculty. The completed
chart must be returned to the chart
room behind the main reception desk
when not in use.
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Student Clinician Handbook, 2003-2004
the left side of the front section of
the patient’s chart.
Quadrant Pain, Ddx. constipation,
IBS.”
10. Problems: Different definitions of
patient Problems in the outpatient
setting, and their use in patient
Assessment and management, have
been described since this convention
began in the 1960s. At BCNH, we
refer to the system designed for use
in family practice as described by
Rakel (Essentials of Family Practice,
1998, pp.96-97). Rakel defines a
Problem as “anything that requires
diagnosis or management or that
interferes with quality of life as
perceived by the patient. It is any
physiologic, pathologic,
psychological, or social item of
concern to either the patient or the
physician.” Rakel delineates further
that a Problem can be anatomic
(hernia), physiologic (undiagnosed
jaundice), a specific diagnosis, a
sign, a symptom, economic
(financial stress), social (family
discord), psychiatric, a physical
handicap, an abnormal lab or
imaging finding, or a risk factor
(personal or family). Note that
“Problem” is a more inclusive, and
often less conclusive, term than
“Diagnosis.” A Diagnosis
communicates the provider’s
certainty of the existence of a
specific disease entity. A Problem
can be a Diagnosis, or it can be a
variety of assessments in progress,
some requiring further evaluation.
Note that a Problem or a tentative or
“working” Diagnosis, because they
are still works in progress, often
require an attached Differential
Diagnosis, whereas a Diagnosis
never has an attached Ddx. For
example, “Problem: Lower Left
a. If the purpose of the charted
visit was to follow-up on a
previously listed problem from a
Problem List, and the Problem
has resolved by inclusion in
another Diagnosis, or by cure or
disappearance, this should be
noted in your Assessment.
Remember that each active
(addressed that day) Diagnosis,
Problem, or Rule/Out demands
corresponding action be noted in
the Plan section that is followedup at a time interval stated in the
Plan. Differential Diagnoses,
listed as an attachment to a
Problem or a tentative diagnosis,
do not demand that
corresponding action be
described in that day’s medical
record.
b. Example: In the Assessment
section of the patient’s chart, the
charting provider can choose to
identify a single Diagnosis or
Problem, or several of them, and
can choose to identify them by
either title as appropriate,
recording them in a list fashion
if there are several. Please do
not confuse this list presentation
of multiple Diagnoses or
Problems with the patient’s
Problem List. The latter,
appearing on the patient’s
Health Data Sheet, is a complete
listing of all the patient’s
Problems, active and resolved,
past and present. The Problems
and Diagnoses that appear in the
patient’s daily chart are only
(and all of) those that were
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Student Clinician Handbook, 2003-2004
actively evaluated or managed
that day. An Assessment might
look like this:
managed at that visit, even if the action
is simply to watch and wait (do nothing).
a. As you create and record this
Plan, consider the Hierarchy of
Therapeutics (Therapeutic
Order) and Naturopathic
Principles, and how these
principles have guided your
Plan. Note these thoughts in
careful detail in the Plan section
of the chart.
c. Assessment: (Rationale or Ddx)
Diagnoses: GERD—Rationale:
secondary to suspected food
intolerance and possible weak
gastric muscle tone and reduced
HCl/pepsin production
Problems: headache—Ddx: atypical
migraine, chronic sinus infection,
eyestrain
b. The Plan section, often charted
as “Future Plan,” should also
include all of your future
planned actions for yourself and
your team, including any
intended follow-up, when you
will next see the patient in the
clinic, any planned phone calls
to the patient, referral research
activities, and coordination of
care.
11. Impression: After you indicate your
active Diagnoses and Problems, you may
then, in your own words, give your
Impression of the patient. Remember to
write this section professionally and
respectfully.
12. Plan: All actions recommended or
prescribed at the present patient visit
must be noted in complete and pertinent
detail in the Plan section of the patient’s
chart. These will include instructions for
diet or lifestyle modification or
intervention; any medication
(herbal/botanical, homeopathic,
neutraceutical, or prescription
medication) with complete and correct
name of product, key ingredients(s) and
amount(s) as appropriate, # of units,
dose and instructions, duration of
dosing, and important side effects about
which the patient was informed and what
they were instructed to do if they occur;
therapeutic application or self-treatment
(with detailed instructions); referrals for
treatment; consultations with specialists;
and laboratory testing or imaging.
Remember that the Plan must contain an
action corresponding to every Problem,
Diagnosis, or Rule/Out evaluated or
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Student Clinician Handbook, 2003-2004
• Barriers to following
recommendations
NUTRITION CLINIC
Nutrition Department Chart SOAP
Noting Principles
Plan:
Goal oriented
Measurable and specific activities
Items in P: are supported by O: and A:
Follow-up activities
General Aim: In addition to accurately
reflecting the event of the appointment,
the focus needs to be on readability,
flow, content and prioritization that is
specific to the patient (focus on chef
complaint or referral).
Clinic Exit Exam Instructions
SOAP Note Style
A format frequently used for medical
record documentation is the problemoriented record or POMR. This record is
organized according to the client’s
primary problems. Entries into the
medical record may be done in many
styles. One of the most common forms is
the SOAP note (Subjective, Objective,
Assessment and Plan), the style used at
the Bastyr Center for Natural Health.
The SOAP format is to be used for any
required medical record documentation
for the Exit Exam, an example of which
follows:
Assessment:
Global Impression statement about the
patient
• Anthropometric – Problem
statement, support of the problem
statement, solution to the
problem statement.
• Biochemical – Problem
statement, support of the problem
statement, solution to the
problem statement.
• Clinical Assessment - Problem
statement, support of the problem
statement, solution to the
problem statement.
SUBJECTIVE (observations,
statements, opinions)
• Diet - Problem statement,
support of the problem statement,
solution to the problem
statement.
• Information provided by the client,
family &/or s.o. or healthcare team
members
Significant reported or stated nutritional
history [e.g., reported or stated wt loss or
gain (intentional or nonintentional) over
a specified time period, N/V/D, appetite
changes, taste &/or smell changes, food
allergies or sensitivities]
• Meds (DNI) - Problem
statement, support of the problem
statement, solution to the
problem statement.
• Motivation to change
• Pertinent socioeconomic information
that has the potential to impact access to
food (e.g. transportation, mobility issues,
sufficient $ to purchase food, reported or
stated cooking facilities to prepare food,
• Understanding of education
provided
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Student Clinician Handbook, 2003-2004
food storage (refrigerator), food
assistance programs used (food banks,
nutrition feeding programs for children
and the elderly, WIC, EFNEP, school
breakfast and lunch programs, soup
kitchens); where a person shops, who
does the shopping, cooking, etc.
tables, 1983 Life Insurance Tables and
Hamwi (Hamwi does not correlate with
BMI, therefore, other methods preferred)
• BMI, adjusted IBW for obesity
• “r” value for frame size, (WHR, TSF,
MAMC values when appropriate)
• Cultural information (ethnic, religious,
foodways that impact food choices,
preferences, avoidances, beliefs
regarding food intake)
• Documented previous weights to show
trends
• Labs (ALB, TTHY, M-7, Hb A1C,
FPG, lipid panel results
• Reported or stated levels of physical
activity and stress
• Prescription meds that have a
nutritional significance (e.g., DNIs)
including those prescribed by a ND
• Current and previous dietary intake
reported or stated. Diet hx (FFQ info,
24-hr recall, food diary or record
information). Summary of food intake at
each meal are recorded in this section;
food avoidances (e.g. states avoids milk
as beverage; does not use salt in cooking
or at the table). Special diets are also
included (low-Na, high-pro, high-fiber)
and amount of fluids, beverages and
water intake per day. Reported food
patterns of intake can also be included
here.
• Nutrient Intake Analysis results
(analysis results of recorded food intake)
For example: NIA (3-d food record
results): 2250 kcal, 45 g pro, 12 g fiber
ASSESSMENT (evaluation of ALL
information presented in the “S” and
“O”)
• Estimated nutritional
needs/requirements and how derived
(kcal, kcal/kg, REE x AF x IF, g pro/kg,
fluid needs (cc/kg, cc/kcal, 1500 cc/m2),
fiber needs/d, electrolyte requirements)
based on stds; NOTE: acceptable to put
in “O”
• Over-the-counter (OTC) meds that do
NOT require a doctor’s prescription such
as nutritional supplements, vitamin
supplements, and botanicals/herbs not
prescribed by a ND (indicate dosages,
times per day)
OBJECTIVE (factual and reproducible
information; must have a paper trail)
• Evaluation, interpretation and/or
assessment of ALL info presented in “S”
and “O” such as:
• Age, gender, ethnicity and diagnoses
(52 YO AAF dx’d Type 1 DM, h/o
obesity)
• Ht and review of weight (current,
UBW, %UBW, % wt change) and IBW
or DBW, %IBW based on 1959 MRW
• Wt, wt changes and significance of
these changes
• Body composition and prediction of
risk for developing chronic disease
• What labs reveal about nutritional
health: generally and specifically
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• Appropriateness of diet order
• Areas of concern, potential for….,
suspect….., client needs….., would
benefit from…..
• Pertinent DNIs with meds (does the
client currently have these sx assoc with
meds or is there increased likelihood that
they may develop these sx?)
• Evaluation of need for nutritional
supplements (
• Discussed …….., provided………, diet
instruction on mgmt of ……..
• Evaluation of nutrition education needs
• Assessment of patient/client
understanding of nutrition education
provided
• Anticipated problems and/or
difficulties for patient/client adherence
or compliance
• Impact of lifestyle on nutritional health
• Assessment of comprehension of
information presented
• Words such as recommend (Rec
referral to ND for f/u r/t anemia), will
(Will call AOM to inquire about
acupuncture and sugar craving relief)
and order (Pls. order ALB and TTHY to
assess visceral pro status) are used in
this section
• Remember that EVERY item in the
PLAN must have been justified in the
“A”
_________________________________
_________________Signature and
credentials
SUPERBILL INSTRUCTIONS FOR
FACULTY AND STUDENTS
Listed below are the superbill fields
that need to be completed or
reviewed by students and/or
supervisors for each patient visit.
PLAN (diagnostic, therapeutic,
patient/client education)
1. Provider Name: Clearly print
the name of the supervising
provider. All superbills must be
initialed by the supervisor.
• GOALS for nutritional therapy
(measurable and outcomes based)
• Recommended labs, diagnostic testing,
consultations to be ordered/completed to
further evaluate nutritional status or care
(Rec check lipid panel, Hb A1C)
2. License #: Clearly print the
license number of the supervising
provider.
• Recommendations for nutritional care
3. Department: Circle the
department and/or program in
which the patient will be seen.
• F/U plans
4. Patient Information: The front
office staff may have already
completed this information.
Make sure that the completed
information is correct and fill in
any missing fields.
a. Name: Patient name
should be printed legibly.
• Specific written instructions involved
that the client agrees to
• Specific recommendations for diet
order changes, MVT/nutritional
supplement changes, etc.)
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b. Date of Birth: Verify
that the date of birth
written on the superbill
matches the date of birth
on the patient’s chart.
c. Date of Service: Verify
that the date of service is
correct.
5. ICD-9 Codes: List each ICD-9
code in descending order of
priority or relevance by which it
relates to the chief presenting
illness. Only list 4 diagnoses on
the superbill even if the chart
notes indicate more than 4
diagnoses. A list of common
diagnoses with ICD-9 codes is
located on the back of the
superbill. If a diagnosis is not
listed on the back of the
superbill, you will need to
consult a current ICD-9 book to
find the correct code. The
Business Office staff is available
to help you determine the correct
codes and to answer your coding
questions.
6. Procedure CPT Codes: Circle
all procedures that were
performed during the visit. In
the column labeled “Dx#”
indicate the associated diagnosis
(1, 2, 3, or 4). As above in #5,
only one Dx# per CPT even if
more than one diagnosis relates
to the procedure. The Dx#
should indicate only the
diagnosis that is the most
significant to the service
performed. There may be
additional diagnoses listed above
that are not tied to a procedure.
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good flow throughout the interview,
without being disruptive. It is
important for you to be involved
with the interview process without
undermining your primary. Ask
questions when it is appropriate and
help fill in gaps that may have been
overlooked by the primary.
INTERVIEW GUIDELINES
PRIMARY ND CLINICIAN
1. The student needs to direct the
interview. While it is important to
hear the patient’s story, it is also
inefficient to let the patient take over
the interview. If a patient seems like
they are not answering your
questions, then politely interrupt
them and help focus them. This may
mean that you do this several times
during an interview, but you will
gain more information in the end.
2. Remember, FOC’s are actually 75
minutes and ROC’S are 45 minutes.
This means that the interview for
FOC should generally be no more
than 45 minutes and ROC’s no more
than 20 minutes. You need to leave
time to do PE, formulate a diagnosis
and treatment plan, discuss the
treatment plan and then present it to
the patient. It is also your
responsibility to help keep the
interview on track.
2. Remember that FOCs are actually 75
minutes and ROC’s are 45 minutes.
This means the interview for an FOC
should generally be no longer than
45 minutes and ROC’s no more than
20 minutes. You need to leave time
to do PE, formulate your diagnosis
and treatment plan, discuss the
treatment plan and then present it to
the patient.
3. It is important to not feel compelled
to get all of the patient's information
in one visit. If the patient has a
complicated history, let them know
up front that another visit may be
required in order to obtain the full
picture. It is important, however,
that their main complaint is
addressed in the first visit.
3. It is important not to feel compelled
to obtain all of the patient's
information in one visit. If the
patient has a complicated history, let
them know up front that another visit
may be required in order to obtain
the full picture. It is important,
however, that their main complaint is
addressed in the first visit.
4. Never discuss any treatment with a
patient during the interview without
consulting the supervising clinical
faculty member first.
4. Never discuss any treatment with a
patient during the interview without
consulting the supervising clinical
faculty member first.
5. You are responsible for all the
patients’ paperwork, including the
superbill, treatment plan and
dispensary sheet. You should keep
blank copies of these with you before
the shift so they are available when
necessary. Each piece of paper
should be filled out in its entirety and
accurately. Treatment plans should
SECONDARY ND CLINICIAN
1. You are there to support the primary
clinician in directing the interview.
The expectation is that you will
assist the primary in maintaining
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Student Clinician Handbook, 2003-2004
be legible, with each provider’s full
name and a rationale for each
treatment recommended. It is
important for patient compliance to
write a good rationale for each
treatment so the patients fully
understand why they are following a
particular regimen.
5. Anticipate the exam that might be
performed and have your equipment
ready. This will streamline your
time management.
6. Alert your supervisor of all
questionable or abnormal findings.
Always ask when needed. The
attending physician must recheck all
positive findings.
PHYSICAL EXAM GUIDELINES
1. You are expected to know every
physical exam you have learned to
date. Your Physical/Clinical
Diagnosis class has taught you most
of what you need to know to perform
a thorough PE. This includes
orthopedic exams, PAP,
gynecological and prostate exams,
etc. Even if you haven’t done one in
a long time or ever, you should still
be familiar with the technique and
appropriate steps in performing that
exam.
SHIFT GUIDELINES FOR ALL
PROGRAMS
Note: some variations exist in each
program (AOM, ND, Nutrition); they are
noted within each point of this section as
applicable.
1.
Clinical faculty will take attendance
at case preview and review of each
shift.
a. If a student is 15 minutes late for
either preview or review, she/he
will be marked absent for that
30 minutes, and will need to
make up that time.
b. If a student misses case preview,
she/he will be marked absent for
the entire 4-hour shift, and that
time will need to be made up.
c. If a student is absent less than15
minutes, the equivalent time will
be deducted from their clinic
time sheet.
2.
Students are responsible for having
their Time Sheet at each shift.
a. Four hours is the maximum that
can be counted on each shift.
b. Students need to have the
supervising doctor/clinical
faculty initial the Time Sheet
each week.
c. Any time missed on a shift due
to absence, lateness, or holiday
will result in an IP for the shift
as incomplete hours. These
2. Vitals need to be taken at each visit,
including Physical Medicine shifts.
Height and weight should be taken as
well.
3. Your equipment should be with you
for each shift and in working order.
You should be checking it the day
before to ensure that everything
works well, batteries are recharged,
etc.
4. A doctor must be present in the room
during a rectal or genital exam. This
is for your legal protection as well as
making sure the exam is done
correctly. If a gynecological exam is
being performed, make sure a female
is present in the room if at all
possible.
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Student Clinician Handbook, 2003-2004
hours will be made up with
substitution shifts as extra hours.
3.
required paperwork in a timely
manner. Note that an excused
absence requires that a clinician
identify and confirm a student
substitute. (See absence policies.)
Students are required to keep a
summary of patient contacts from
all shifts, interim clinic and sub and
extra time. These are to be
recorded on the Summary of
Patient Contacts Form, and each
patient contact must be initialed by
the supervising doctor/clinical
faculty directly involved with each
patient. ND and Nutrition: Must
designate each contact as either
Primary (P) or Secondary (S).
AOM: Must designate each contact
as either FOC or ROC. Students
must use a separate form for each
shift for sub/extra time.
4.
Hours lost due to absences, snow
days or holidays need to be made
up at some point before graduation.
100% of program hour
requirements need to be completed.
5.
ND, Nutrition and AOM: At least
80% attendance is required to
receive a grade of IP (in progress)
which will convert after missed
hours are made up to achieved
competency for each quarterly shift
(holidays and emergency closures
excluded). Two excused absences
per shift are allowed. Three
excused absences for an IP grade
may be allowed under special
circumstances at the discretion of
the supervisor, otherwise the
student will receive an F grade for
the shift. Four or more absences
will result in a failure for the shift,
with loss of all hours and patient
contacts. An excused absence is an
absence for which the student has
properly filled out and returned all
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6.
An unexcused absence is defined as
not being on a scheduled shift and
failing to notify the scheduled
supervising clinical faculty member
of your absence prior to the start of
the shift. The first unexcused
absence during a term will result in
the student clinician being required
to complete three shifts [12 hours].
A second unexcused absence will
result in the loss of the entire shift.
The supervising clinical faculty
member may, at their discretion,
accept notification of an absence
after the start of the clinic shift in
the event of an extraordinary
emergency. Even if the student
calls the supervisory clinical
faculty member prior to the missed
shift, the supervisor reserves the
right to define the missed shift as
an unexcused absence and sanction
the student accordingly. This
would occur if, in the estimation of
the supervisor, the reason for the
student's absence does not warrant
missing the shift. Any unexcused
absence must be reported to the
Clinic Department Coordinator.
7.
All AOM chart notes must be
completed at the time of the
treatment. All ND and Nutrition
student clinicians must complete
chart notes for all patient visits and
phone contacts within 24 hours of
the contact. Incomplete charts
must be appropriately labeled and
notes and treatment plan from the
Student Clinician Handbook, 2003-2004
visit must be in the chart. These
charts must remain in the clinic at
all times and are left in the
supervising clinical faculty’s “chart
box”. Violation of this policy will
result in a clinic sanction, resulting
in loss of that day's shift hours and
patient contacts. Repeated
violations of this policy will result
in a failure of the entire quarterly
shift. (Including loss of those shift
hours, and patient contacts).
8.
reviewed beforehand. All lab work
and medical records should be in
the chart ready to be discussed.
Students should become familiar
with Section on Lab and the
Section on Dispensary in the Clinic
Handbook. The charts are left by
the student behind the front desk in
designated chart return area. The
charts are refiled by the front desk
in the chart room. The student
must complete a chart review
notice for each chart to their
supervisor alerting the supervisor to
review and sign the completed
chart. These notices must be
placed in the supervisor's clinic
mailbox.
CASE PREVIEW PROTOCOL FOR
ALL PROGRAMS
The following are recommendations to
make case preview a better learning and
teaching experience:
1.
Case preview is the first 30 minutes
of each 4-hour shift.
2.
Start promptly. Clinic supervising
clinical faculty is responsible for
starting and ending case preview on
time. Clinic supervisors should be
familiar with the day’s cases.
3.
Students should be prepared to start
on time with all of their cases
108
4.
Each student team from each room
presents a brief identification of
their patients scheduled on the
shift, with their chief complaints.
a. Patient age, sex and race if
relevant.
b. Chief complaint(s).
5.
Then, going one room at a time, the
primary student clinician should
present the reason or purpose of the
days’ visit for each of the patients
in their room. The clinician should
include other relevant information
on each case, namely age of
patient, sex, race and chief
complaints.
6.
If this is an ROC, a short summary
should be presented of past data
pertinent to understanding the
differential diagnosis, and the
response of the patient to the
treatment. Also note future plans.
A discussion of that day’s plan
should be presented.
7.
If this is an FOC, a discussion of
the complaint listed should occur
that includes possible diagnosis,
confirmatory exams, and
therapeutic ideas.
8.
All the other student clinicians
should be attentive to each case, in
order to learn from it and offer any
input they might have.
9.
By the end of case preview, all the
cases will have been discussed as a
group, and the students prepared to
Student Clinician Handbook, 2003-2004
start the first scheduled patient’s
care.
5.
10. If students are more than 15
minutes late for case preview
without prior arrangement or an
emergency, there will be no credit
given for case preview, and the 30
minutes time will need to be made
up at a future date. Shift supervisor
will mark absent on the CP (case
preview) section of the attendance
sheet for that shift.
11. This is valuable time that should be
used to prepare and educate the
supervising physician/clinical
faculty and student clinicians for
the shift’s patients.
SUBJECTIVE
1. Patient information
2. Introductory comment
3. Chief complaint(s) and its (their)
duration
4. HPI- present a succinct version of
the HPI
5. Pertinent positive findings from
appropriate ROS section(s)
6. Pertinent risk factors and family
history
7. PMH - give only pertinent
information
8. Allergies - all allergies including
drug reactions (include type of
reaction)
9. Medications - all present
medicines, dosages and indications
for taking
10. Lifestyle - pertinent information on
work, school, home environment,
sleep, exercise, diet, relationships,
habits
11. ROS - state only pertinent positives
(other than those mentioned in
HPI)
12. Finish case preview with the group
after 25 minutes, to allow 5
minutes for students to get ready to
start on time with their patients,
and time to discuss cases on an
individual basis if needed.
CASE REVIEW PROTOCOL FOR
ALL PROGRAMS
[YOUR CASE PRESENTATION MUST BE
CONCISE AND TO THE POINT.
THIS SHOULD BE DONE IN 6 TO 7
MINUTES.]
1.
2.
3.
4.
on each patient identifying the
chief complaints and the diagnosis.
Supervising physicians/clinical
faculty will then choose the best
teaching cases and have the student
clinicians present each case with
the following format: (NOTE:
Students are encouraged to present
their cases from memory without
reading excessively from the
patient’s chart.)
Clinic supervising
physicians/clinical faculty is
responsible for starting and ending
case review on time.
Case review is the last 30 minutes
of the 4-hour shift.
Any student more than 15 minutes
late for case review without
supervisor approval will not receive
credit for case review. The 30
minutes will need to be made up to
receive credit.
At the beginning, student clinicians
from each room will report briefly
OBJECTIVE
Physical Examination
1. Introductory sentence - describe
appearance and condition
2. Vital signs
3. Pertinent positive findings describe findings
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Student Clinician Handbook, 2003-2004
facility where the information
originated.
Laboratory Tests and Diagnostic Studies
1. State pertinent positives and
significant findings
2. State pertinent negatives if they are
significant
3. State significant past results, if
available
3.
Copies sent to another clinic/health
care practitioners are sent at no
charge, as a professional courtesy.
A patient who wants information
for personal use, or to hand carry to
another provider will be given 15
pages at no charge. Copies in
excess of 15 pages will be charged
at the full rate.
4.
All copies sent to parties not
directly involved in patient care
will be charged at the full rate.
5.
Medical Records Personnel collect
completed authorizations for
processing. The form must be
signed and dated by the patient,
include the outside facilities
address, patient date of birth, and
patient’s daytime phone number.
The student clinician should tell the
patient that it will take 7 – 10
business days to process the
request. Outside release forms
must include special authorization
for information related to sexually
transmitted diseases, HIV and
AIDS, substance abuse or mental
health and counseling.
6.
When medical records personnel
receive information, that
information is placed in the chart
and they are placed in requesting
provider’s box.
7.
Medical record personnel must
process all outgoing requests and
incoming records. This includes all
records received by FAX. Medical
Records must also process any
ASSESSMENT
Problems and Diagnoses, Differential
Diagnosis and Rule/Outs.
PLAN
Treatment recommendations,
philosophical principles employed,
future plans and expected outcomes
should be summarized.
PATIENT MANAGEMENT
POLICIES
MEDICAL RECORDS
All medical records requested and/or
received must be processed via the
medical records department.
1.
2.
Please tell patients who want
records of their charts sent to
another health care practitioner, or
to themselves, that the patient must
complete a Release of Information
Form. Only information that
originated at BASTYR CENTER
FOR NATURAL HEALTH will be
released and only with signed
authorization. There may be a
charge for patients wanting records
for personal use or to hand-carry to
another provider. There is always a
charge to send patient information
to parties not directly involved in
patient care.
Copies of information from other
health facilities will not be released
to patients. They may contact the
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Student Clinician Handbook, 2003-2004
information mailed directly to the
NHC providers.
8.
Current Procedural Terminology
(CPT)
1. The Bastyr Clinic uses CPT codes
according to the standards agreed
upon by CMS and associated
medical groups. The chosen CPT
codes reflect the level of service
provided during each patient visit.
The supervising clinician is
responsible for choosing the correct
CPT code for the visit, and for
recording it on the patients billing
and lab forms.
If a patient is being seen
simultaneously by different
providers, it is permissible for the
Bastyr supervisor/student team to
include copies of relevant labs or
progress notes with written referral
letters with a summary of treatment
letters to these other providers. It is
also permissible for these providers
to share information from the
patient records with one another as
part of consultation conversations.
2.
Important principles for choosing
CPT codes include:
INSURANCE
a. A new patient is one who has
not received any professional
services from the clinician or
another clinician of the same
specialty who belongs to the
same group practice, within the
past three years.
PROVIDER PARTICIPATION IN
THIRD PARTY REIMBURSEMENT
1. The Bastyr Center participates in
third party reimbursement systems.
All providers at the Bastyr Center
are required to contract with the
health insurance or other
reimbursing agencies designated by
the Bastyr Center, and to timely
and fully maintain current
applications, documentation,
current copy of license, etc., and
contracts with these agencies.
2.
b. Counseling is defined as a
discussion with a patient and/or
family concerning diagnostic
results, impressions or
recommendations, prognosis,
risks evaluation and risk
reduction, patient instructions
for treatment and follow up,
importance of compliance,
patient and family education.
Counseling does not include
psychotherapy.
Providers are expected to correctly
apply the standard systems of ICD9, CPT, and Documentation
Guidelines for Evaluation and
Management Services as agreed
upon by the World Health
Organization, the Centers for
Medicare and Medicaid Services
(CMS), and associated medical
groups. Salient aspects of these
systems are outlined in sections
that follow.
c. Three components of an office
visit are key to determining the
level of E/M service. They are:
History, Examination, and
Medical Decision
Making/Complexity.
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Student Clinician Handbook, 2003-2004
d. The quantity of detail, counted
as elements, in areas of History
of Present Illness/Chief
Complaint (HPI/CC),
Past/Family/Social History
(PFSH), Review of Systems
(ROS), and Physical
Examination further impacts
the level of CPT chosen.
Risk Reduction Intervention (99401404).
DOCUMENTATION GUIDELINES
(DG)
The Bastyr Center uses Documentation
Guidelines for Evaluation and
Management Services as agreed upon
by CMS and the AMA. Bastyr Center
medical record instruments accurately
model the principles of these DG,
including Bastyr Center ROS and PE
forms. Summaries of DG appear at
corresponding location in these
instruments for the clinician’s
convenience. Clinicians are responsible
for ensuring that each patient’s medical
record at each visit is in compliance
with these guidelines. Principles for
correct medical record keeping
according to the Documentation
Guidelines for Evaluation and
Management Services include
documentation of:
e. Time, in reference to a patient
visit, equals face-to-face time
working with the patient.
f. There are five E/M levels of
risk and complexity: Minimal,
Self-Limited, Low, Moderate,
and High.
g. To select a CPT code for a
New Patient Visit, the E/M
services provided must meet or
exceed established criteria in
all three key components
described above. A return
office visit must meet or
exceed only two, and one must
be the level of medical decision
making/complexity.
a. Chief Complaint (CC) of complaints
b. History of Present Illness (HPI)
including pertinent elements of
location, quality, severity, duration,
timing, context, modifying factors,
and associated signs and symptoms.
h. In the case where counseling
and/or coordination of care
constitutes more than 50% of
the clinician/patient and/or
family encounter (face to face
time), then time alone
becomes the determining
CPT factor. Quantity of time
must be documented.
c. Review of Systems (ROS) including
pertinent elements of Constitutional
symptoms, Eyes,
Ears/Nose/Mouth/Throat,
Cardiovascular, Respiratory,
Gastrointestinal, Genitourinary,
Musculoskeletal, Integumentary
(Skin and/or Breast), Neurological,
Psychiatric, Endocrine,
Hematological/Lymphatic,
Allergic/Immunologic
i. The CPT code series most used at
Bastyr Clinic in ND patient care are
Office or Other Outpatient Services
(99201-205, 99221-215), Preventive
Medicine Services (99381-387,
99391-397), and Counseling and/or
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Student Clinician Handbook, 2003-2004
d. Pertinent elements of Past, Family,
and/or Social History (PFSH).
for choosing the correct ICD-9
code for the visit, and for recording
it in the medical record and on the
patient billing form. Instructions
for choosing ICD-9 codes are
found in the front of reference
texts.
e. Pertinent elements of Examination
including examinations of
Cardiovascular,
Ears/Nose/Mouth/Throat, Eyes,
Genitourinary (Male and Female),
Hematological/Lymphatic/Immunol
ogic, Musculoskeletal,
Neurological, Psychiatric,
Respiratory, and Skin Organ
systems or areas.
3.
a. The most specific code
available for the patient's
condition must be identified.
f. Pertinent factors of Complexity of
Medical Decision Making including
Number of Diagnoses or
Management Options, Amount
and/or Complexity of Data to be
Reviewed, and Risk of Significant
Complications, Morbidity, and/or
Mortality
b. The first diagnostic code
referenced on the billing form
must describe the primary of
most important reason for the
care provided. This is called
the Primary Diagnosis.
c. The ICD-9 code chosen must
be consistent with and
substantiated by information
recorded in the subjective,
objective, assessment and plan
sections of the patients written
record.
g. An Encounter Dominated by
Counseling or Coordination of Care,
particularly the element of time.
h. The correct number of elements of
CC, HPI, ROS, PFSH, and
Examinations to correspond with
the Complexity of Medical Decision
Making and CPT chosen.
d. Every condition, and only the
conditions, actively addressed
during the patients present
clinic visit must be assigned a
specific ICD-9 code. All ICD9 codes pertaining to an
individual patient visit must be
recorded in the required
locations in the written record,
including the assessment
section. However, only 4 ICD9 codes should be listed on the
billing form.
INTERNATIONAL
CLASSIFICATION OF DISEASES
(ICD-9)
1. The Bastyr Center uses ICD-9
codes, or diagnosis codes,
according to the standards agreed
upon by the World Health
Organization and relies upon
reference texts to describe these
standards.
2.
Important principles for choosing
ICD-9 codes include:
During each patient visit the
supervising clinician is responsible
e. All ICD-9 codes must be
numbered by priority on each
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Student Clinician Handbook, 2003-2004
billing form and in the patient
chart.
On the following four pages you will
find the BCNH Patient Care CPT
Coding Worksheet. It is to be used
optionally by supervisors or student
clinicians on shift as a guide to choosing
the correct CPT code for the level of
visit complexity, the number of history
elements obtained, and the number of
physical exam elements performed. All
criteria included in the tables are derived
from the Documentation Guidelines.
f. Please refer to Documentation
Guidelines for Evaluation and
Management Services, in the
Appendix, for more detailed
information.
4. Patient Care CPT Coding Worksheet
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PATIENT CARE CPT CODING WORKSHEET
[Not to be filed with the Medical Record]
Figure 4 Patient Care CPT Coding Worksheet
New Patients:
Requires all three Key Components – History, Physical Exam and Decision Complexity.
Code
History
Physical Exam
Decision
Counseling
Complexity
[Health]
99201 Focused
CC:
1 System/Area
Straight Forward 10 minutes
HPI [1-3] areas
[1-5 elements]
99202 Expanded CC:
1+ Systems
Straight Forward 20 minutes
Problem Focused HPI [1-2]
[6 elements]
ROS [1] areas
99203 Detailed
CC:
6 Systems/Areas Low
30 minutes
HPI [4-7]
w/2 Elements or
ROS [2-9]
2 Systems/Areas
PFSH [1] areas
w/12 Elements
99204
CC:
9 Systems/Areas Moderate
45 minutes
Comprehensive
HPI [4-7]
w/2+ Elements
ROS [10]
PFSH [3]
99205
CC:
9 Systems/Areas High
60 minutes
Comprehensive
HPI [4-7]
w/2+ Elements
ROS [10]
Return Patients: Requires 2 of the following 3 Key Components – History, Physical
Exam, and Decision Complexity
Code
History
Physical Exam
99212 Focused
CC: HPI
99213 Expanded
Problem Focused
CC:
HPI
ROS [1]
CC:
HPI
ROS [2-9]
PFSH [1]
CC:
HPI
ROS [10]
PFSH [3]
1 System/Area
[1-5 elements]
1+ Systems
[6 elements]
99214 Detailed
99215
Comprehensive
6 Systems/Areas
w/2 Elements or
2 Systems/Areas
w/12 Elements
9 Systems/Areas
w/2+ Elements
115
Decision
Complexity
Straight Forward
Counseling
[Health]
10 minutes
Low
15 minutes
Moderate
25 minutes
High
40 minutes
Student Clinician Handbook, 2003-2004
History of Present Illness [HPI] Includes the
Elements Listed Below
Location
Quality
Severity
Duration
Timing
Context
Modifying Factors
Associated Signs and Symptoms
HPI Notes
Past Family and/or Social History (PFSH)
Consists of a Review of 3 Areas
Past History: The patients past experiences
with illnesses, operation, injuries, and
treatments
PFSH Notes
Family History: A review of medical events
in the patients family, including diseases which
may be hereditary of place the patient at risk
Complete PFSH: At least one specific item
from each of the three history areas must be
documented.
Brief HPI: The medical record should
describe 1-3 elements of the present illness.
Extended HPI: Description should include at
least 4 elements of the HPI or the status of at
least 3 chronic or inactive conditions.
Pertinent PFSH: At least one specific item
from any of the three history areas must be
documented of a pertinent PFSH.
Social History: An age appropriate review of
past and current activities
Review of Systems [ROS]
For purposes of ROS, the systems listed below
are recognized:
Constitutional Symptoms [e.g. fever, weight
loss, etc.]
Eyes
Ears, Nose, Mouth, Throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
Hematological/Lymphatic
Allergic/Immunologic
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ROS Notes
Problem Pertinent ROS: The patient's
positive responses and pertinent negatives for
the system related to the problem should be
documented.
Extended ROS: The patients positive
responses and pertinent negatives for 2 – 9
systems should be documented
Complete ROS: At least 10 organ systems
must be reviewed. Those systems with
positive or pertinent negative responses must
be individually documented. For the
remaining systems, a notation indicating all
other systems are negative is permissible. In
the absence of such a notation, at least 10
systems must be individually documented.
Student Clinician Handbook, 2003-2004
Figure 5 Physical Exam Elements Required Should be Circled Below by Doctor
Vitals
Height________________________________
Weight________________________________
RR___________________________________
HR___________________________________
BP___________________________________
Temp_________________________________
General Appearance_____________________
Cardiovascular
Palpation/Auscultate
Heart_________________________________
Edema________________________________
Carotids_______________________________
Abdominal Aorta_______________________
Femoral Arteries________________________
Pedal Pulses____________________________
Eyes
Conjunctive/Lids_______________________
Pupils/Iris_____________________________
EOM________________________________
Fundus_______________________________
Chest/Breast
Inspection_____________________________
Palpation of Breasts/Axillae_______________
Ears/Nose/Mouth/Throat
External
Ears/Hearing___________________________
Otoscopic Exam________________________
External Nose/Nasal Mucosa______________
Lips/Teeth/Gums_______________________
Oral Mucosa/Pharynx____________________
Gastrointestinal
Examination of Abdomen_________________
Liver/Spleen____________________________
Check for Hernial_______________________
Anus/Rectum__________________________
Guaiac________________________________
Neck
Genitourinary [Male]
Examine Neck__________________________ Penis_________________________________
Palpation of Thyroid_____________________ Scrotum_______________________________
Prostate_______________________________
Respiratory
Genitourinary [Female] Pelvic Exam
Effort_________________________________ External Genitalia_______________________
Percussion of Chest______________________ Urethra_______________________________
Bladder_______________________________
Cervix________________________________
Uterus________________________________
Ovaries_______________________________
Vaginal Mucosa________________________
Lymphatic Palpation in 2+ Areas
Skin
Neck_________________________________ Inspect_______________________________
Axillae________________________________ Palpate_______________________________
Groin_________________________________
Other______________________________
Musculoskeletal
Gait__________________________________ Examine joints/bones/muscles of 1+ of the
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Student Clinician Handbook, 2003-2004
Digits/Nails____________________________
following 6 areas:
Head/Neck____________________________
Inspect or palpate for misalignment,
Spine/Ribs/Pelvis_______________________
asymmetry, crepitation, etc:
Right Upper Extremity___________________
ROM_________________________________ Left Upper Extremity____________________
Stability_______________________________ Right Lower Extremity___________________
Muscle Strength/Tone____________________ Left Lower Extremity____________________
Neurologic
Cranial Nerves_________________________
Sensation_____________________________
DTR’s_______________________________
Psychiatric
Describe patients judgment and
insight________________________________
_____________________________________
Mental Status Including:
Orientation in
Time/Place/Person_______________________
Memory:
Recent________________________________
Remote_______________________________
Mood/Affect___________________________
Other Comments/Additional Instructions:
Notes for Coding
Problem Focused: A limited examination of
the affected body area or segment or organ
system. 1-5 elements.
Expanded Problem Focused: A limited
examination of the affected body area or organ
system and any other symptomatic or related
body area or organ. 6+ elements.
Detailed: An extended examination of the
affected body area of organ system and any
other symptomatic or related body area or
organ system. At least 2 elements from each of
the 6 areas or at least 12 elements in 2+ areas.
Comprehensive: A general multi-system
examination of a single organ system and other
symptomatic or related body area or organ
system. All elements in at least 9 areas.
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PATIENT SCHEDULING
not make any requests to restrict
FOC’s in their rooms.
Student clinicians are encouraged to
contact and bring in your own patients
through community education, public
talks, participating in wellness clinics
and health fairs, and talking to your
friends. You can also go back through
past clinic patient files and call patients.
Please see your clinic supervisor or the
Medical Director first.
1.
2.
During spring quarter, 4th or 5th
year ND and 3rd year AOM
graduating student clinicians need
to begin the process of providing a
smooth transition of transferring
the primary responsibility of care
for your patients to the third year
student clinicians under the same
supervising faculty. You are
required to notify your patients,
your supervising physicians, and
the student clinicians you are
referring the patient to about this
transition, and to note this transfer
in the patient chart. This transition
will take place by graduation, so
that all patients will continue with
the same supervising
physician/clinical faculty and new
fourth year student as the primary
student clinician. Once you
graduate, you will not be able to
see patients until you are licensed
as a physician (ND) or as an
acupuncturist with NCCA
certification (AOM). You must
graduate and pass the board exams,
and obtain your license in order to
see patients.
3.
If arranging an appointment for a
patient, students need to have the
patient call in to schedule an
appointment. Students must never
schedule appointments. It is fine to
tentatively arrange with a patient
when to come in, but the patient
must be the one to actually contact
the front desk to schedule the
appointment.
4.
You must have your patients
scheduled on regular clinic shift
time.
PATIENTS REFERRED TO CLINIC
Note: some variations exist in each
program (AOM, ND, Nutrition); they are
noted within each point of this section as
applicable.
1. All programs (AOM, ND, Nutrition):
A thank you letter should be
composed, typed and sent to any
referring physician in appreciation
for sending her/his patient to us.
2. All programs (AOM, ND, Nutrition):
A letter summarizing the patient’s
visit and/or treatments should be sent
to a referring physician after an
appropriate number of visits,
typically three visits, or after
pertinent diagnostic or therapeutic
outcomes are achieved.
3. ND only: Patients directly referred
by another physician or supervising
clinical faculty for lab tests, physical
medicine treatment or dispensary
items may be seen and/or treated
without the usual FOC work-up. A
The front desk has a system of
scheduling FOC’s that is fair for
everyone. Student clinicians may
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Student Clinician Handbook, 2003-2004
chart should be made up with a
note/short summary of the
complaint/care from the referring
physician and what type of treatment
she/he wants for her/his patient in
physical medicine. If a patient does
not bring the appropriate written and
signed information from the referring
physician, please telephone the
referring physician for authorization
and document appropriately.
INTRACLINIC REFERRALS
Student clinicians are encouraged to
consider referrals to other departments
within the clinic. There is an intraclinic
referral letter (see templates and
examples beginning on page 264) which
should be filled out and signed by the
supervisor for all intraclinic referrals.
Referred-to clinicians/supervisor teams
are encouraged to write treatment
summary notes at the conclusion of
entries back to the referring supervisor
and clinicians.
AOM /ND/ NUTRITION PATIENT
REFERRALS TO OUTSIDE
PHYSICIANS/HEALTH CARE
PROVIDERS
1. A brief referral letter should be
typewritten by the primary or
secondary student clinician to
either send with the patient to the
acupuncturist/health care
practitioner, or to be mailed. This
letter should include the patient’s
identifying information, the
presenting complaints and other
relevant subjective information,
any objective findings, the
assessment or rule outs (differential
diagnosis), the reason for the
referral and what tests or diagnostic
procedures to perform. State
whether or not the
acupuncturist/health care
practitioner should institute
treatment as she/he sees
appropriate, or whether she/he
should consult back with the
supervisor first. This letter needs
to be signed by the
acupuncturist/health care
practitioner, photocopied and the
original sent with the patient and
the copy placed in the chart.
Templates and sample letters
appear in the Appendix and are
available from your supervisor.
POLICY AND PROCEDURES ON
PROVIDING HEALTH SERVICES
TO MINORS
These policies and procedures establish
efficient and consistent mechanisms for
handling both the care and treatment of a
minor at the Bastyr Center for Natural
Health ("Center"), along with privacy
related issues involving a minor's health
records.
For purposes of the following
procedures, a minor is any person under
the age of eighteen (18).
PROCEDURES:
Can a minor consent to his or her own
medical treatment?
General rule. Persons under the age of
18 may not consent to their own medical
treatment unless one of the exceptions
listed below applies. If none of the
exceptions apply, parental consent to
medical treatment is necessary for the
provision of medical services to persons
under the age of 18.
Exceptions. Below is a list of the
exceptions most applicable to the
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Student Clinician Handbook, 2003-2004
operations of the Center setting forth
when persons under the age of 18 may
be able to consent to their own medical
treatment:
If a minor cannot consent, who is
authorized to consent on behalf of a
minor? Any of the following
individuals may consent to a minor’s
medical treatment:
Reproductive Health and Gynecological
Services. An unmarried minor of any
age may consent to treatment involving
the minor's reproductive autonomy (for
example, examination and prescription
for birth control or diagnosis and/or
treatment of sexually transmitted
diseases).
Either Parent of the Minor. Either
mother or father of a minor patient.
A Minor Parent that is Married to a
Spouse Eighteen (18) Years or Older. If
the minor parent is married to a minor,
or if there are dual minor parents,
whether they may provide valid consent
is determined by the Emancipation
factors set forth above.
Life-Threatening Emergency.. Consent
for care is implied by law when
immediate treatment is required to
preserve life or to prevent serious
impairment of bodily functions and it is
impossible to obtain the consent of the
minor or parent or legal guardian.
Legal Guardian. A signed copy of the
court order establishing guardianship
should be obtained and filed with the
minor's medical record.
Marriage. A minor is capable of giving
informed consent if the minor is married
to a spouse eighteen (18) years or older.
Authorized Department of Social and
Health Services (DSHS) Representative.
A copy of the court order establishing
that the minor is in custody of DSHS,
and that an authorized DSHS
representative may consent to medical
treatment for the minor, should be
obtained and filed with the minor's
medical record.
Judicial or Clinical Emancipation. The
minor must submit a signed copy of the
court order evidencing emancipation
along with satisfactory proof of
identification ("Judicial Emancipation").
Photocopies of both must be maintained
in the patient's file. In the alternative,
the Director of the Clinic may find that
the minor is emancipated for purposes of
receiving medical treatment. Such a
finding should be based on the following
and documented in the minor's medical
record: the patient's age, maturity,
intelligence, training, experience, and
the economic independence from
parental control that the minor exercises
("Clinical Emancipation").
How may consent be given? The
individuals listed in Sections A-H above
("Authorized Individual(s)") may
consent to treatment on behalf of a
minor by signing a written consent form
on the minor's first visit to the Clinic. In
addition, please refer to the Clinic's
Informed Consent Policy for additional
requirements.
In the event that an Authorized
Individual is unavailable and
delegates authority to consent on
behalf of a minor to another
individual (for example, a
Mental Health: A minor, thirteen (13)
years or older, may consent to mental
health treatment.
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Student Clinician Handbook, 2003-2004
related to health care, then the parent or
legal guardian may access and control
disclosure of the minor's medical records
and/or health information.
grandparent) then the Authorized
Individual shall provide a written
delegation statement authorizing the
other individual to consent to
treatment on behalf of the minor. The
delegation statement should be signed
and dated by the Authorized
Individual and should state:
If a minor is authorized to consent to
his or her own medical treatment and
is covered as a dependent under
insurance, can the Center submit the
claim for reimbursement?
“I, [name of parent] am the parent or
legal guardian of [name of child] and am
authorized to consent to diagnosis and
medical treatment on their behalf. In the
event I am personally unable or
unavailable to provide such consent, I
hereby authorize [name of designate] to
consent to [name of chile]'s medical
treatment at the Bastyr Center for
Natural Health.”
The Center may submit information
to the insurance company in the
ordinary course. In addition, the
Center should submit all necessary and
customary information to obtain
payment for services rendered, even it
the services were rendered to a minor
under an exception listed above.
SOURCES FOR POLICY AND
PROCEDURES ON PROVIDING
HEALTH SERVICES TO MINORS
The requirement of a written consent
form or delegation statement may be
waived in emergency situations or at the
discretion of the Director of the Center.
Consent For Providing Medical
Treatment To A Minor.
Who has access to a minor’s medical
records?
When Minor May Consent. A minor
may consent to medical treatment in the
following situations:
When Minors Control Their Medical
Records and/or Health Information. If
the minor consented to the treatment
pursuant to one of the exceptions above,
the minor has the rights of access and
control of disclosure regarding his or her
medical records and/or health
information. The Center should treat
requests for disclosure from anyone
other than the minor like any other
request for patient information from
someone other than the patient.
1. Age. A minor's consent is valid if
the minor is over the age of eighteen
(18). RCW 26.28.015.
2. Emancipation. A minor's consent is
valid if the minor is Emancipated.
RCW 13.64.060. In Washington,
Emancipation of a minor is
evidenced through:
3. A Judicial Determination. The
minor must submit a court order
evidencing minor's Emancipation; or
When a Parent or Legal Guardian
Controls a Minor's Medical Records
and/or Health Information. If parent or
legal guardian has authority to act on
behalf of the minor in making decisions
4. A Clinical Determination. The
healthcare provider considers that the
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Student Clinician Handbook, 2003-2004
minor is Emancipated for purposes
of receiving medical treatment, and
documents in the patient's medical
records, the age, maturity,
intelligence, training, experience,
economic independence, and the
freedom from parental control that
the minor exercises. Smith v. Seilby, 72
involving the reproductive autonomy
of the minor.
9. Minor Seeking Drug or Alcohol
Abuse Outpatient Treatment. A
minor thirteen (13) years of age or
older may consent to counseling,
care, treatment or rehabilitation for
outpatient treatment for conditions
and problems caused by drug or
alcohol abuse. RCW 70.96A.095.
Wn.2d 16, 431 P.2d 719 (1967).
5. Marriage. A minor's consent is
valid if the minor is married to a
spouse eighteen (18) years or older.
RCW 26.28.020. A minor married to a
minor may give consent if
Emancipated (see Emancipation,
above).
10. Mental Health Testing and
Treatment. A minor, thirteen (13)
years or older, may consent to
inpatient and outpatient mental
health treatment. RCW 71.34.030 and
RCW 71.34.042.
6. Life-Threatening Emergency.
Consent for care is implied by law
when immediate treatment is
required to preserve life or to prevent
serious impairment of bodily
functions and it is impossible to
obtain the consent of the minor or
parent or legal guardian. RCW
Valid Parental Consent. If none of the
above situations apply, a parent must
provide consent for treatment of the
minor. A parent's consent is considered
valid if received from:
1. Either Parent of the Minor.
18.71.220.
2. A Divorced Parent with Legal
Custody.
Minor with Sexually Transmitted
Disease (STD). A minor fourteen (14)
years or older may consent to
examination and treatment for an STD
without the consent or knowledge of
parent or guardian. RCW 70.24.110.
3.
7. Gynecological Services. Provided
she is capable of giving informed
consent, an unmarried minor
fourteen (14) years or older may
consent to gynecological care,
including examination and
prescriptions for birth control.
A Divorced Non-Custodial Parent,
Where the Custodial Parent
Cannot Be Reached, and Custodial
Parent has not Previously
Objected to Medical Treatment.
RCW 26.09.310.
4. A Minor Parent that is Married to
a Spouse Eighteen (18) Years or
Older. If the minor parent is
married to a minor, or if there are
dual minor parents, whether they
may provide valid consent is
determined by the Emancipation
factors set forth above.
8. Reproductive Services. Provided
she is capable of giving informed
consent, an unmarried minor of any
age may consent to treatment
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Student Clinician Handbook, 2003-2004
5.
Legal Guardian. A signed copy of
the court order establishing
guardianship should be obtained and
filed with the minor's medical
record. RCW 26.09.310.
9. When a Parent or Legal Guardian
Controls a Minor's Medical
Records and/or Health
Information. If parent or legal
guardian has authority to act on
behalf of the minor in making
decisions related to health care, then
the parent or legal guardian may
access and control disclosure of the
minor's medical records and/or
health information.
6. Authorized Department of Social
and Health Services (DSHS)
Representative. A copy of the court
order establishing that the minor is in
custody of DSHS, and that an
authorized DSHS representative may
consent to medical treatment for the
minor, should be obtained and filed
with the minor's medical record.
Disclosure under Insurance Policy
Submission of Health Information by
Provider. All health information
necessary and required to process claims
should be submitted by a provider to
health plans and insurers.
7. Minor's Confidential Medical
Records and/or Health
Information
8. When Minors Control Their
Medical Records and/or Health
Information. A minor may access
and control disclosure of his or her
medical records and/or health
information if the minor may provide
consent for his or her own treatment.
RCW 70.02.130.
Duty of Health Plans and Insurers.
Under the Washington State Patient's
Bill of Rights, health plans and insurers
may not send an explanation of benefits
form to a policyholder if it would violate
the privacy rights of a covered
dependent. RCW 48.43.021.
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Student Clinician Handbook, 2003-2004
performed by the Lab staff unless other
arrangements have been made through
the lab for supervising a student
performing a lab test.
CLINICAL LABORATORY
LABORATORY WORKFLOW AND
HOURS OF OPERATION
Laboratory hours of operation are as
follows:
If you need a result before your patient
leaves, please mark this request and the
time by which you need it on the lab
requisition and verbally notify the
laboratory personnel.
Open 8:30 a.m. to 8:30 p.m. Monday,
Tuesday, Thursday
8:30 a.m. to 5:00 p.m.
Wednesday and Friday
If you need the result immediately,
please indicate STAT on the requisition
and verbally notify the laboratory
personnel. This request should only be
used in the event of an emergency, since
most of the work is done ASAP.
Closed 12:30 until 1:30 on all days
4:30 until 5:30 on Monday,
Tuesday, Thursday
If the lab staff must be out of the lab for
any reason and will be gone longer than
10 minutes, there will be written
instructions in the lab indicating where
to find the tech and when to expect them
to return.
Any specimen brought to the lab later
than 10 minutes before closing will be
accepted and billed. However, the test
may not be run and result will not be
released until the next shift.
All laboratory testing is done on a firstcome basis during the shift.
All specimens are to be placed on the
island bench. LABEL: patient last
name, first name; date collected; source.
Place completed lab requisition in wall
rack.
Every lab procedure that we perform or
send out must be coded and billed
appropriately. The reality is that even
though the student or provider may draw
the specimen and/or perform a lab test,
there remain resources that have been
utilized.
Processing and/or testing of a sample
can take up to 30 minutes to perform
depending on what is requested. It is
during the immediate post-closing time
that work already requested is finished,
and the laboratory is cleaned and
disinfected for the next day. All lab
work be brought to the lab or be
requested 30 minutes prior to the lab’s
posted closing time. Should there be an
emergency that may require the lab to
remain open past its closing time, please
notify the lab personnel as soon as
possible.
Any discounts or special rates will be
determined by the clinic policies in
place.
For patients who need Laboratory work
during closure hours, please re-appoint
them to another shift or day.
Students may make blood draws under
strict supervision. All lab tests are to be
LABORATORY TEST FEES AND
BILLING
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Student Clinician Handbook, 2003-2004
Only laboratory personnel will quote test
fees. When discussing options with
patients, the telephone in the exam room
may be used to get this information. If
there is no telephone, or the laboratory
personnel are unable to pick up a call,
the secondary clinician must come to the
laboratory.
Health and external reference lab
requisition forms, correctly filled out and
signed by a supervising physician.
When tests are ordered in advance of
sample collection the requisition(s) are
filed in the Lab. Patients must schedule
with the Appointments Desk for a lab
appointment and sample collection
unless a lab test is needed on-shift,
STAT. Any ND supervisor may order
lab tests STAT and when doing so
should make the nature of the order very
clear to the lab technician.
Reference laboratories may have a
multi-tiered fee schedule. When this is
the case, a discussion with laboratory
personnel is required to clarify which
schedule to apply. Criteria to determine
such application include:
Samples collected from patients in
exam/treatment areas must be handled
and transported to the Lab in accordance
with OSHA guidelines, including
containing samples completely and
transporting in a gloved hand(s).
Insurance coverage
Payment at time of service option
Payment included with specimen option
Specific reference laboratory offering
the requested test(s)
Original reports of lab test results will be
placed in the ordering physician’s
mailbox for review, response and
signature, whereupon the physician will
route the reports to the patient’s chart for
filing by placing the signed report in the
loose paperwork or reviewed medical
records box hanging on the outside of
the chartroom door. Duplicate copies of
all lab reports are stored for two months
in the Lab.
Laboratory personnel do patient billing
for laboratory testing. Based on the
above criteria, a bill will be generated
which will be taken to the front desk as
it is completed. The provider is
responsible for indicating that
laboratory testing was requested for the
patient during the visit, by circling the
“LAB” heading on the visit superbill.
Any tests that are subsequently
requested will be billed to the patient by
the testing entity.
LABORATORY RESULTS TO BE
CHARTED: FILE LOCATION
Thanks for your help in making this a
habit. It will insure that all bills are to
the front desk in a timely manner, and
will key the front desk personnel to look
for the bill.
It is the responsibility of the Clinic
Medical Records office to chart the
official, final copy of all lab results. If it
is necessary to find a result that is not
yet charted, the laboratory maintains
copies of all patient results.
REQUESTING LABORATORY
TESTS
The copy is not the official document
and MUST be returned to the
laboratory.
Laboratory tests are to be ordered using
appropriate Bastyr Center for Natural
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Student Clinician Handbook, 2003-2004
lab test result(s) with the patient. This
can be accomplished at a scheduled
appointment or by telephone, as
appropriate.
A file for various medical records is
located in the 2nd floor hall across from
the copier. The doctor is responsible for
bringing results that are ready to be
charted to this file. Medical Records
personnel check the file several times
during the week and will place the
results into the appropriate chart(s). If a
chart cannot be found, the result(s) will
be held in the Medical Records office.
Please direct all requests to that office.
The laboratory requisition form is given
to the patient’s student clinicians, who
are responsible for bringing it to the
laboratory.
Laboratory staff is responsible for
submitting the laboratory bill to the front
desk, with the appropriate charges
marked. The results are to be given to
the ordering physician.
LABORATORY TESTS
REQUESTED BY NON-ND
PROVIDERS
This policy is to be followed in the event
of an acute need for patients being seen
in clinics where a Naturopathic
physician is not the primary care
provider.
GYNECOLOGICAL CYTOLOGY
SERVICES
Papanicolaou (PAP) staining of
endocervical, ectocervical, and vaginal
smears is an important aspect of
women’s health care. A separate
Cytology notebook details the services
offered. This notebook is available from
the Client Services staff and includes
sections on:
The provider currently seeing the patient
comes to the ND patient care areas and
locates an ND with whom to consult, at
no charge to the patient. The ND has the
option of seeing the patient and to order
the test(s) or not, after their assessment
of the situation. The ND may also decide
that it is most appropriate to schedule an
ND office call for a more complete
evaluation.
1. General Information
2. Specimen Collection
3. Patient Statistical and Follow-up
Reports
4. Terminology/Classification
Standards
5. Special Services
If the ND agrees to order the test(s) that
day, they are responsible for personally
filling in and signing a laboratory
requisition form, to ensure all
information is entered correctly. It is the
responsibility of the patient’s original
clinical team to advise the patient that a
brief ROC may be scheduled with the
ordering ND to discuss the test results,
per the ND’s instructions during the
consultation. Please note that the
consulting ND is responsible for all
follow-up and intervention regarding the
Collection supplies including slides,
cytobrush, modified Ayre spatula, and
Pap Paks are available at no charge from
the Laboratory.
COLLECTION TECHNIQUES
Almost all cancers of the cervix begin
near the squamocolumnar junction. It is
imperative, therefore, that smears be
taken from this area. There are 2
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collection media available: Pap Pak and
SurePath.
the brush as this may macerate the
collected cells.
INSTRUCTIONS FOR USING PAP
PAK
Prior to obtaining the cervical sample:
If hormonal evaluation is needed, an
additional smear may be obtained by
scraping the lateral VAGINAL wall.
This sample should be thinly spread on a
separate slide and fixed
IMMEDIATELY in the fixative from
the Pap Pak. Label slide M.I.
(Maturation Index).
Write the patient’s name in pencil on the
frosted end of the glass
Have a Pap Pak opened.
Indicate on the request form all pertinent
information about the patient such as last
menstrual period, radiation therapy,
IUD, clinical cancer, hormone therapy,
previous abnormal cytology.
Notes and Precautions:
The ectocervical sample initially
gathered in a small area at one end of the
slide should not be allowed to air dry.
The endocervical sample should be
collected promptly and mixed with the
ectocervical sample. The combined
sample material is then spread thinly and
evenly over the entire slide (excluding
the frosted label area) to prepare the
smear.
Excess mucus should be removed from
the uterine cervix and vagina before the
samples are taken.
Ectocervical Sample – Using a
modified wooden Ayre spatula, obtain a
sample from the ECTOCERVIX. Rotate
and scrape the external OS. The sample
material should be gathered into a small
area at one end of the slide. Then collect
the endocervical specimen promptly, and
do not allow the ectocervical specimen
to air dry.
Lubricant should not be used as it
obscures cellular detail.
The use of a cytobrush can significantly
improve the collection of endocervical
cells at the squamocolumnar junction.
The following cautions govern their use,
however:
You may want to inform your patients
that, due to the thorough sampling of the
endocervical canal by the cytobrush,
there may be some minor painless
spotting for a day or two following the
PAP test.
NEVER reuse the cytobrush.
Insufficient clinical data exists regarding
its use on pregnant patients. DO NOT
USE on pregnant patients.
The cytobrush MUST NOT be used for
sampling from the endometrium.
Endocervical Sample – Using a
cytobrush, obtain a second sample from
the ENDOCERVIX. Rotate within the
endocervical canal. Please note that a
cytobrush should not be used on
pregnant patients.
Smear Preparation – Mix the
ectocervical and endocervical samples
together with the brush, and then roll the
brush across the entire slide (excluding
the frosted label area) creating an even
and thin smear. Fix immediately in the
fixative from the Pap Pak. Do not slide
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Upon review by Bastyr University law
firm, the statutory limitation in this
aspect of our law is that a N.D. may not
"treat malignancies” except “in concert
with” an M.D. or D.O. Therefore, if an
N.D. is providing care to a cancer
patient for any purpose other than
treatment of his or her malignancy,
there is no unusual limitation to the
N.D.’s scope of practice.
INSTRUCTIONS FOR USING
SUREPATH
1. Cervical Sample Collection: Insert
the Rovers Cervex-Brush® into the
endocervical canal. Apply gentle
pressure until the bristles form against
the cervix. Maintaining gentle pressure,
hold the stem between the thumb and
forefinger. Rotate the brush five times
in a clockwise direction. (NOTE: BE
SURE TO ROTATE BRUSH FIVE
TIMES.)
However, when a N.D. is providing
curative treatment for the malignancy,
the N.D. is within his or her scope only
if the curative treatments are “in concert
with” an M.D. or D.O. There is no
formal guidance on what it means to be
acting “in concert with” an M.D. or
D.O. from either the courts or the
Department of Health. Mr. Burgon has
advised us in this regard as follows.
2. Preserve the entire sample: Placing
your thumb against the back of the brush
pad, simply disconnect the entire brush
from the stem into the SurePath®
preservative vial.
3. Cap and label vial: Place the cap on
the vial and tighten. Label the vial and
lab requisition form with patient name
and/or number, physician name and date
if desired.
1. At a minimum, the N.D. must be
confident that she or he is fully
aware of the M.D.’s prescribed
course of treatment. This is likely to
require interaction with the M.D. or
D.O. in order to obtain the necessary
medical records or other direct
knowledge of the patient’s treatment.
NATUROPATHIC TREATMENT
OF MALIGNANCY
Chapter 18.57 or 18.71 RCW of the
naturopathic licensing law states:
“The practice of naturopathy includes
manual manipulation (mechanotherapy),
the prescription, administration,
dispensing, and use, except for the
treatment of malignancies or neoplastic
disease, of nutrition and food science,
physical modalities, homeopathy, certain
medicines of mineral, animal, and
botanical origin, hygiene and
immunization, common diagnostic
procedures, and suggestion; however,
nothing in this chapter shall prohibit
consultation and treatment of a patient in
concert with a practitioner licensed
under chapter 18.57 or 18.71 RCW.”
2. It is important to note, however, that
the N.D. does not have to be
subservient to the M.D.’s direction.
The N.D. must only provide
treatment that is in harmony with the
medical regimen and must inform
the M.D. of the treatment being
provided.
In light of this interpretation, we have
revised the informed consent form for
the treatment of malignancies (see
attached). It is your responsibility to
ensure that any patient for whom you are
treating malignancy, the symptoms
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thereof, or the side effects of their
conventional treatment for their
malignancy, sign this consent form prior
to your treatment.
Under Title VI of the Civil Rights Act of
1964, the Office for Civil Rights has
determined that language assistance is
appropriate when language barriers
cause persons with limited English
proficiency (LEP) to be excluded from
or denied access to clinical services.
The key to ensuring equal access for the
LEP client is to ensure that the service
provider and the LEP client can
communicate effectively, i.e. the LEP
client should be given information about,
and be able to understand, the services
that can be provided by the provider and
must be able to communicate his/her
situation to the provider.
And, to summarize your role:
In order to treat patients with
malignancy we must:
1. be fully aware of the patient’s M.D.
or D.O.’s prescribed course of
treatment, as documented in the
patient’s medical records or as
documented from a charted
conversation that you have had with
the patient’s M.D. or D.O
In order to meet these guidelines for
services provided to LEP patients by
Bastyr Center for Natural Health
providers, there are several interpreter
options:
2. provide treatment that is in harmony
with the patient’s conventional
treatment (to the best of the medical
profession’s current state of
knowledge)
1. A health care provider is required to
obtain “informed consent” prior to
commencing treatment. The
Center’s Informed Consent form is
written in English. It is imperative
that an interpreter translate this form
in its entirety to the LEP patient so
that the patient is able to give
informed consent to treatment (or
non-treatment). This consent is
indicated by the patient’s signature
on the Informed Consent form.
2. While the provider cannot require a
patient to use family members or
friends as interpreters, a family
member or friend may be used as an
interpreter. It is important that the
use of a family member or friend not
compromise the patient’s
confidentiality or the effectiveness of
services. According to Washington
state law on patient confidentiality, a
patient’s confidentiality may be
3. regularly inform the patient’s M.D.
or D.O. of the treatment that you are
providing to the patient.
As long as a patient is under the care of
an M.D. or D.O. for their malignancy,
we may treat this patient’s malignancy.
If a patient has refused the treatment
recommended by their M.D. or D.O., we
must document their voluntary informed
refusal of that treatment. We must
continue to adhere to the above stated
communication guidelines in your care
of this patient.
INTERPRETER SERVICES
POLICY
After a thorough legal review, the
following policy regarding interpreter
services provided by Bastyr Center for
Natural Health has been formulated.
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compromised by the use of a family
member or a friend as an interpreter
if highly sensitive areas, such as
HIV/AIDS, sexually transmitted
diseases, drug and alcohol treatment
and mental health issues, are
discussed. Given these guidelines,
the supervising faculty provider must
assess whether the confidentiality or
effectiveness of services is
compromised by a patient using a
family member or friend as an
interpreter. If confidentiality or
effectiveness of services is deemed
to be compromised, other interpreter
options must be pursued.
interpreters is the responsibility of the
clinic, and in some cases, may be shared
with the patient’s health insurer.
TELEPHONE CONTACT POLICY
Please observe the following rules for
phone contact:
1. The clinic phones are for clinic
business only.
2. All calls to patients must be preapproved by the supervising
physician/clinical faculty.
3. If the patient’s residence is long
distance, you must obtain permission
to call from a supervisor and use a
clinical faculty phone.
4. Calls to/from patients should be
limited to 3 minutes. These calls
should be limited to determining the
status of the patient, reporting test
results, clarifying treatment
instructions, or recommending
follow up. If the call is longer than
this, consider scheduling the patient
for an office call, or consultation. A
phone contact should not replace an
office visit.
5. You are legally responsible for
phone advice. A note in the chart
must be made with the date, reason
for the call and any pertinent
information or advice. You and the
supervising physician/clinical faculty
should then sign this. Do not offer
any new treatment advice or change
any treatment plan without the
approval of the supervising clinical
faculty.
6. There is a student phone in the
lounge that should be used for local,
personal calls.
7. Students should never give home
phone numbers to patients. Any
business that you need to discuss
with a patient should take place at
the clinic in person or by phone.
A student who is proficient in the
patient’s language and in the English
language and who is familiar with
medical terminology is considered a
competent interpreter. Thus, student
clinicians may act as interpreters for
LEP patients with the permission of the
patient and the approval of the
supervising faculty member.
The AT&T Language Line may be used
to provide interpretation and translation
for patients. This service will need to be
pre-arranged by the front desk staff in
coordination with the patient. Any costs
incurred in the interpretation are the
responsibility of the patient.
LEP patients may use certified
interpreters. The patient is responsible
for making arrangements for these
interpreters and for paying these
interpreters. The front desk will provide
contact information for interpreter
services to interested patients.
Under the American Disabilities Act, all
clinical service providers are required to
provide sign language interpreters for all
deaf persons. The cost of these
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Pagers/Cell Phone Usage:
1. All pagers and cell phones must be
on vibratory alert mode while in the
clinic. Furthermore, it is not
permissible to answer these calls in a
room with a patient during a patient
visit.
2. Urgent calls may be answered
outside of patient care rooms.
emergency or urgent nature. From
this point forward, it will be the
responsibility of the observing or
secondary student in each room to
make sure that the volume of the
telephones is at an audible level.
Failure to comply may result in a
failure event for that student.
Please know that we are in a process
of developing a triage system for
paging calls. This process should
result in fewer and only essential
pages. If you have any questions
about this policy or telephone
operation, please contact your shift
supervisor.
3. Clinic Telephone Paging System
While paging may be disruptive to a
patient visit, it is critical that student
clinicians and supervisors be able to
hear pages at all times. All
telephone pages require immediate
attention; some pages are of an
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
SENTINEL EVENTS PROCEDURE:
REPORTING AN OCCUPATIONAL
ACCIDENT/ILLNESS EVENT
5.
It is understood that this procedure is for
any occupational injury or illness
occurring on the Clinic premises or
caused by the working environment.
6.
In case of illness:
1. Notify supervisor
2. Supervisor shall complete the
‘Occupational Illness/Injury Report
Form’ with employee
3. Employee shall be seen by a provider
of their choice (at the Clinic or
elsewhere)
4. Supervisor shall immediately
forward paperwork to Human
Resources
5. Safety Coordinator will forward
paperwork to Human Resources
Department within 24 hours of the
incident and continue the evaluation
process (see section V.B.)
7.
8.
Contact appropriate emergency
responders per provider’s
instructions
Supervisor and provider will begin
appropriate paperwork with
employee as soon as possible
following the illness
Supervisor will forward paperwork
to the Clinic Safety Coordinator
within 24 hours of the incident
Safety Coordinator will continue
evaluation process (see section V.B.)
Emergency transport of patient will
be 911 vehicle
In case of a Sentinel Event:
A Sentinel Event is defined as an
unexpected occurrence involving death
or physical or psychological injury, or
the risk thereof. Such events are called
“Sentinel” because they signal the need
for immediate investigation and
response.
Front desk is notified and is responsible
for the following:
1. Page senior ND provider to the site
using the in-house emergency
contact schedule
2. Arrange for exam room
3. Furnish ‘Occupational Illness/Injury
Report Form’ to provider/supervisor
4. Contact appropriate emergency
responder per instructions from
provider
5. The following administrators must
be notified immediately:
 Dean of Clinical Affairs
 Clinic Medical Director
 Clinic Administrator
 Clinic Safety Coordinator
 Clinic Department Coordinator
6. Paperwork requirements: Supervisor
or provider must complete the
‘Occupational
In case of accident:
1. Notify employee/student’s
supervisor
2. Supervisor shall immediately contact
nearest available ND provider and
then contact the front desk
3. Provider is responsible for physical
assessment of any injury and shall
approve moving the injured person
only if safe to do so. Please refer to
Emergency Manual located in the
laboratory.
4. Front desk is responsible for the
following:
 Furnish ‘Occupational
Illness/Injury Report Form’ to
provider/supervisor
 Arrange for an exam room
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SENTINEL EVENTS PROCEDURE:
REPORTING A PATIENT/VISITOR
ACCIDENT/ILLNESS EVENT
Injury/Illness Incident Report Form’, to
include:
a. Date, time, and place of incident
b. Complete detailed description of
incident, including any objects
involved
c. Nature of incident
d. Indicate basic cause and any
contributing cause(s)
7. Safety Coordinator completes
investigation of events.
8. Safety Coordinator conducts
interviews with all persons directly
involved.
9. Safety Coordinator presents
evaluation to Clinic Safety Committee,
which is responsible for the following:
10. Review evaluation
11. Develop action plans and establish
timelines for completion, including
but not limited to:
a. Documentation of response to the
incident
b. Identification of deficiencies
c. Suggestions for improvement(s) to
the response
d. Write recommendation(s) and
send to:
 Supervisor/provider who was
directly involved
 Clinic Program Coordinator
 Clinic Medical Director
 Clinic Manager
 Dean of Clinical Services
12. OSHA 2000 Log and Summary
Form is required to be completed for
each event, and is the responsibility of
the Safety Coordinator.
13. Copies of all paperwork will be
forwarded to the Bastyr University
Health and Safety Office on the Main
Campus.
It is understood that this protocol is to
be for any injury or illness occurring on
the Clinic premises or as a result of a
product purchased from the
Naturopathic Dispensary or the Oriental
Medicine Dispensary .
In case of illness/accident on the
premises of the Clinic:
1. Front desk is notified and is
responsible for the following:
a. Page senior ND provider to the
site using the in-house emergency
contact schedule
b. Arrange for exam room
c. Furnish ‘Patient/Visitor Incident
Report Form’ to the provider of
record
2. Provider of record completes top
portion of form and forwards paperwork
to the Clinic Safety Coordinator within
24 hours of the incident.
3.
Safety Coordinator/Risk
Management Officer is responsible for
contacting the University’s liability
company.
4.
Safety Coordinator shall copy all
paperwork to the Clinic Medical
Director and Manager within 24 hours.
5.
Emergency transport of patient
will be 911 vehicle.
In case of injury from or adverse
reaction to any product purchased
from the Clinic:
1. Dispensary staff notifies supervisor
to discuss event with patient.
2. Supervisor is responsible for the
following:
a. Determines extent of problem;
refer to Emergency Manual located
in clinic lab.
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‘Injury/Illness Incident Report
Form’, to include:
• Date, time and place of incident
• Complete detailed description
of incident, including any
object(s) or machinery
involved
• Nature of incident
• Indicate basic cause and any
contributing cause(s)
b. Refers patient to provider if
necessary to discuss specific nature
of problem.
3. Dispensary staff and/or supervisor is
responsible for the following:
a. Completes top portion of
‘Patient/Visitor Incident Report
Form’, and
b. Forwards paperwork to Clinic
Safety Coordinator within 24 hours
of the incident.
3. Safety Coordinator is responsible for
the following:
a. Completes investigation of
events
b. Conducts interviews with all
persons directly involved
c. Presents evaluation to Clinic
Safety Committee which is
responsible for the following:
4. Review evaluation; develop action
plans and establish time lines for
completion, including but not limited to:
In case of a Sentinel Event:
A Sentinel Event is defined as an
unexpected occurrence involving death
or physical or psychological injury, or
the risk thereof. Such events are called
“sentinel” because they signal the need
for immediate investigation and
response.
1. Front desk is notified and is
responsible for the following:
a. Page senior ND provider to the
site using the in-house
emergency contact schedule
b. Arrange for exam room
c. Furnish ‘Patient/Visitor Incident
Report Form’ to provider of
record
d. Call appropriate emergency
responder per provider
instructions
a. Documentation of response to the
incident
b. Identification of deficiencies
c. Suggestions for improvement(s)
to the response
5. Write recommendation(s) and send
to:
 Supervisor/provider who was
directly involved
 Clinic Program Coordinator
 Clinic Medical Director
 Clinic Administrator
 Dean of Clinical Services
6. Follow-up by Safety Coordinator, as
recommended by the Committee
7. Clinic Medical Director shall contact
patient as deemed necessary to ensure
patient satisfaction
8. Copies of all paperwork will be
forwarded to Bastyr University Health
and Safety Office on main campus.
2. The following administrators must be
notified immediately:
a. Dean of Clinical Affairs
b. Clinic Medical Director
c. Clinic Administrator
d. Clinic Safety Coordinator
e. Clinic Department Coordinator
3. Paperwork requirements:
a. Supervisor or provider must
complete the top portion of the
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COMMUNICABLE DISEASE
OUTBREAK
Guidelines for dispensing information to
Bastyr University and center for Natural
Health employees and students in event
of communicable disease outbreak.
Once the shaking has stopped depart the
building immediately, via the safest,
closest emergency exit. The SAFE
ZONES (or meeting area) will be 100
feet away from the building, towards the
schoolyard.
Initial Contact
1. Testing facility notifies Clinic
Laboratory of positive result
2. Bastyr Clinical Laboratory notifies
3. Provider of Record
4. Clinic Safety Officer
Floor Safety Wardens, if conditions are
not hazardous, will sweep the Center.
Their students, staff and patients will
meet in the safe zone to await
instructions from the Emergency Policy
Director (Dean of Clinical Affairs,
Clinic Medical Director or Clinic
Manager).
Safety Officer notifies Clinic Medical
Director
The highest-ranking member of the
Center will act as the Emergency Policy
Director. They will go to the Safety
Meeting Zone. The Emergency
Operation Director (generally will be the
Manger of Operations) will direct the
facilities personnel (if safe) to inspect
the building to look for building integrity
and any broken lines that would pose a
danger.
Medical Director notifies:
1. Clinic and Campus personnel via
email/voicemail
2. Clinic Students via written notices
on bulletin board in student lounge
and via email.
3. University Health and Safety Office
via email
4. If unable to contact directly, notify
Student Services Office
The facilities staff will return to report
their findings to the Emergency
Operation Director. The Emergency
Operation Director discusses this
information with the Emergency Policy
Director. The Emergency Policy
Director will then decide whether to call
an All Clear or extend the post
evacuation period and call necessary
Emergency Professionals.
University Health and Safety Office of
Student Services Office notifies students
via written messages on various
designated bulletin boards, i.e. the white
board and others.
EARTHQUAKE RESPONSE PLAN
When you recognize that an earthquake
is occurring, if able drop to the floor and
take cover under a sturdy desk or table.
Hold on to this furniture, as they may be
moving. If this is not available, seek
cover against an interior wall and protect
your head and neck with your arms.
Avoid danger spots such as windows,
mirrors, hanging objects or tall furniture,
which could topple over.
MISCELLANEOUS
PARKING
Students must use on-street parking. The
Wallingford Plaza (Bastyr Center for
Natural Health building) parking lot is
reserved for patient parking. Your car
will be towed if you violate this rule. It
is suggested that student clinicians
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Student Clinician Handbook, 2003-2004
attempt to carpool, use Metro, or bicycle
if possible.
by providers. A patient may be
recommended to receive a series of
weekly or even more frequent physical
medicine visits, however is unable to
comply with the recommendation due to
lack of available physical medicine
appointments. This does not provide
optimal care for these patients.
COPY MACHINE
The copy machines are for clinic
business only. Personal copies,
including copies of class notes, need to
be made outside of the clinic.
Data shows that Bastyr students and staff
seek physical medicine services at a
significantly higher rate than other
services provided at the Center. Many
of these visits appear to be self-referred.
ANNOUNCEMENTS AND
COMMUNICATIONS
Announcements and other
communications are placed in the
student mailboxes in the lounge.
General clinic information is posted in
the student resource room. Phone
messages are posted on the bulletin
board in the hallway off the Front Desk
area.
While these visits are important to the
health of the student or staff, the volume
of these self-referred visits is posing a
significant barrier to patients with
referred or provider-recommended
physical medicine visits. In order to
mitigate this situation, we are asking all
Bastyr students and employees to do the
following for Physical Medicine
appointments:
STUDENT CLINICIANS MUST
CHECK THEIR MAILBOXES AND
THE STUDENT PHONE MESSAGE
BOARD EACH TIME THEY ARE IN
THE CLINIC. STUDENT
CLINICIANS ARE RESPONSIBLE
FOR KNOWING AND RESPONDING
TO ALL INFORMATION IN THEIR
MAILBOXES AND ON THE
MESSAGE BOARD, AS
APPROPRIATE.
First, see if your needs can be met at the
Physical Medicine shifts on campus.
Capacity at this campus program has
recently been expanded.
For non-urgent, self-referred visits,
please do not seek Phys Med
appointments at the Bastyr Center for
Natural Health more than one week in
advance of when you would like to be
seen. Please be advised that beginning
Friday, November 1, 2003, we will only
make appointments for non-urgent, selfreferred visits in Physical Medicine for
members of the Bastyr Student and
Bastyr Employee health plans within one
calendar week of the request on a spaceavailable basis. This means, if you call
on a Friday, for a non-urgent
appointment, we will try to schedule you
for that Friday through the next
GUIDELINES FOR STUDENTS,
FACULTY, AND STAFF: MAKING
APPOINTMENTS IN PHYSICAL
MEDICINE
As many of you may know, the Physical
Medicine shifts at the Bastyr Center for
Natural Health are generally very busy
and completely booked with
appointments on any given day. This is
terrific but it does present some
challenges in serving our patients. We
find that we are often unable to
accommodate the physical medicine
component of treatment plans prescribed
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Student Clinician Handbook, 2003-2004
Thursday. If there are no openings, you
will need to call back later for an
appointment. Under this policy,
“urgent” means you currently have an
injury or illness that is in some way
incapacitating to your daily activities
and which could be treated with physical
medicine. Visits for general well being,
physical complaints that are more
chronic and not incapacitating or
preventative health are considered nonurgent.
Winter quarter 2003 which will also help
with appointment availability. In the
meantime, we thank you for your
cooperation and understanding.
BASTYR UNIVERSITY
RESIDENCY PROGRAM
The Bastyr Center for Natural Health has
a CNME accredited residency program.
Currently, there are first-year and
second-year naturopathic and AOM
residency positions. This is a highly
competitive program and attracts
graduates from other educational
institutions as well as from Bastyr. The
residency program at Bastyr is a closely
supervised program of mentorship. Each
resident evolves from an observational
role into an independent role over the
course of the year. This progression is
monitored and facilitated by a faculty
mentor and by the Residency Program
Director. A second year of naturopathic
residency consists of clinical supervision
and continued skill development. All
residents have multiple opportunities to
do rotations in other local centers both
allopathic and naturopathic.
If you are ill or injured and need to make
a Physical Medicine appointment we
will attempt to schedule you in as soon
as possible just like any other patient.
If you are seeking a Physical Medicine
appointment as part of a recommended
treatment plan, we will attempt to
schedule you in as soon as possible just
like any other patient.
When you have an appointment, please
don’t cancel on short notice except in an
emergency. This applies to
appointments in any department.
Canceling on short notice is discourteous
to the patient care team and other
patients who need an appointment.
We will try this procedure for a while to
see if it improves the appointment
availability in Physical Medicine for all
patients. Please bear in mind that our
goal is to be able to service all patients
better, including Bastyr students, faculty
and staff and their partners and
dependents, by insuring that the ill and
injured can be seen on short notice and
in accordance with treatment plans
prescribed by their providers.
The Bastyr University Residency
Program is designed to provide an
opportunity for naturopathic and AOM
medical school graduates to strengthen
their skills as a naturopathic and/or
AOM primary care provider. The
residency program will provide residents
the opportunity to enhance their
knowledge and skills in family medicine,
application of naturopathic philosophy,
teaching and practice management. The
residency program has specific
knowledge, skill, and attitude
competencies that are consistent with the
progressive level of training throughout
the course of the residency.
This process will be reviewed after a
trial period to see if it is having the
desired effect. Some capacity will be
added in Physical Medicine starting
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The Bastyr Center for Natural Health is
the primary teaching facility of the
Bastyr University Residency Program.
There are currently 6 first year and 2
second year resident positions in the
naturopathic program. There are 3 first
year and 1 second year resident positions
in the AOM program. While the
majority of the clinical rotation is within
the Center, residents are given the
opportunity to participate in shifts in offsite clinics, such as the 45th St. Homeless
Youth Clinic and Covenant Shores, that
are supervised by members of the core
clinical faculty.
2.
3.
4.
5.
Goals of The Bastyr University
Residency Program:
1. To produce in our residents ethical
naturopathic physicians and
acupuncturists who are highly
6.
139
competent in the practice of
naturopathic/AOM family medicine.
To develop skilled clinical educators
in the natural health sciences that
integrate mind, body, spirit and
nature.
To teach our residents core skills
essential to leadership roles in a wide
range of health care systems.
To maintain an emotionally
supportive environment, encourage
intellectual debate, and foster lifelong professional development.
To give our residents the opportunity
to provide high quality naturopathic
care to the people of our community
regardless of the socioeconomic
status.
To assist our residents in actively
participating with clinical staff of the
Bastyr Center of Natural Health that
enhances the quality of medical care
in our community.
Student Clinician Handbook, 2003-2004
CLINICAL COMPETENCIES
STUDENTS AT BASTYR CENTER FOR NATURAL HEALTH WILL
DEVELOP COMPETENCIES IN THE CLINICAL SKILLS REQUIRED FOR
PROFICIENCY IN THEIR CHOSEN DEGREE
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CLINICAL COMPETENCIES
Clinic Qualities
CLINIC MISSION
The mission of Bastyr Center for Natural
Health is to create an extraordinary
environment committed to excellence in
health care and clinical education that
assists and empowers individuals and the
community to achieve better health and a
higher quality of life.
Heritage
Students in the BCNH will develop an
understanding and acknowledgement of
the rich heritage inherent in natural
medicine and all forms of medicine.
Students will appreciate the philosophy
and essence of wholism that natural
medicine embodies.
UNIVERSITY GLOBAL
COMPETENCIES
Integration
Students in the BCNH will develop the
skills and professional competence
necessary to demonstrate integration
between disciplines, modalities and
philosophies.
Communications skills
Students in the BCNH will develop
writing and speaking skills that will
enable them to communicate in a
professional, appropriate and effective
manner to colleagues, other health care
providers, patients, and the public.
Students will be able to actively listen to
their patients, colleagues, other health
care providers and the public and to
integrate this information into their case
management. Students will develop their
clinical intuition. Students will develop
literacy in medical and professional
information.
Career Management
Students in the BCNH will develop
competence relating to professional
responsibilities, career and business
management. The students will
participate in their professional
community.
Critical Thinking
Students in the BCNH will demonstrate
the ability to think critically illustrating
their knowledge, comprehension,
application, analysis, synthesis, and
evaluation of information.
Professional Behavioral
Students in the BCNH will conduct
themselves professionally and
responsibly with regards to medical
ethics, compassionate behavior, crosscultural differences, respectful
communication and personal health and
wellness.
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treatments for the same biomedical
disease require different treatments
based on changes in pattern
differentiation as the disease progresses
or is ameliorated by ongoing treatment.
Chinese medical assessment is a
dynamic and evolving process that looks
at the total state of the patient as this
state evolves.
AOM CLINICAL COMPETENCIES
PRINCIPLES OF TRADITIONAL
CHINESE MEDICINE
Chinese medicine is a holistic practice
based on medical practice dating from
before the Han Dynasty (206 BCE to
220 ACE). TCM therapeutics are
determined by assessments based on
pattern differentiation.
Chinese medicine is based on the theory
that patterns of energy (Qi) flow
through the body, interconnect the
individual's internal and external
environments, and are affected by the
larger universe. Individuals and their
energy are affected by external
extremes called the six exogenous
pathogenic influences, which are wind,
cold, damp, dryness, summer heat, and
fire as well as the seven emotions,
which are joy, anger, melancholy,
worry, grief, fear and fright. Additional
factors that contribute to the onset of
disease are overworking, improper diet,
lack of physical exercise, traumatic
injury, phlegm fluid accumulation,
stagnant blood, and insect or animal
bites.
Holism is the principle that the whole
body-mind spirit is greater than the sum
of these individual parts. Chinese
medical practice is directed at the
harmonizing of all aspects of the bodymind-spirit, rather than assessing and
treating a single physiologic problem in
a reductionist manner. This style of
practice is based on the principle that no
part of the body-mind spirit functions in
isolation and that any disharmony will
act at many points distal to the initial
disharmony.
Chinese medical differentiation is based
on the determination of a pattern of
disharmony. This pattern of
disharmony is based on a detailed
assessment of the signs and symptoms
the patient presents at the time of
treatment. Such an assessment is tied to
the state of the body-mind-spirit at the
time of assessment, and as such is much
less dependent on the determination of
an etiology antecedent to the pattern
differentiation. The result of focusing
on pattern differentiation is that a group
of patients with a single biomedical
disease diagnosis may have different
patterns of disharmony, and may require
different treatments, each based on a
unique pattern differentiation. An
emphasis on pattern differentiation at the
time of treatment will also mean that a
patient over a course of multiple
Illness and disease are represented as
disharmonies between opposites (yin
and yang, interior or exterior, cold or
hot, excess or deficiency). When yin
and yang are in proper dynamic
relationship, an individual will be able
to adapt to the environment in a way
which is not only free from disease
(either active or subclinical), but also in
a way that promotes growth and an
individual perception of wellness. In
this sense, the root cause for the
occurrence and development of disease
can be understood as the imbalance of
yin and yang. An individual will be
able to withstand the assaults of the six
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exogenous pathogenic influences, seven
emotions and other factors discussed
above as long as yin and yang are in
dynamic equilibrium.
Despite the many adaptations that have
evolved over the centuries, the core
principles remain the same in all
medical systems derived from Chinese
medicine. One of the primary
principles in Chinese medicine is that
human life is expressed as a mixture of
the influence of heaven (yang/energy)
and earth (yin/matter) in dynamic
equilibrium.
Thousands of years of clinical
experience and scholarly research and
discussions have lead to a complex and
detailed accumulation of medical
theories involving the human body and
its physiological functions. The broad
categories of these theories are the
organ systems (zang fu); vital
substances (qi, blood, and body fluids,
jing); and meridians and collaterals.
The meridians and collaterals are
pathways in which the qi and blood of
the human body are circulated. There
are twelve regular meridians, eight extra
meridians, twelve divergent channels,
twelve tendomuscular regions, twelve
cutaneous regions, as well as fifteen
collaterals. They form the network that
connects interior organs, tissues, and
physiological processes into an organic
whole. Acupuncture and moxibustion
techniques are employed along these
pathways in order to restore the
dynamic equilibrium of yin and yang of
individuals. Other techniques used to
restore balance to the individual are
herbal medicine, cupping, tui na, dietary
advice and qi gong.
A person who practices Chinese
medicine must therefore be dedicated to
life-long learning, rooted in both a
material (scientific) understanding of
life and a more energetic (esoteric)
realization of all possibilities.
MISSION STATEMENT
The AOM clinical program is designed
to integrate the rich history of traditional
Chinese medical methods with the study
of modern sciences and the
contemporary practice of acupuncture
and oriental medicine.
AOM TIMELINES AND
OBJECTIVES
Each student clinician during his/her
career at the Bastyr Center for Natural
Health demonstrates competency at
numerous clinical skills. One way of
keeping track of the progressively
expanding expertise of a student
clinician is by a system of
skills/performance evaluations designed
to be completed sequentially by term.
Here is a time line for all AOM student
clinicians. After each term is completed,
the student will receive written feedback
or will meet with their clinic supervisor
to discuss how well they have completed
their shift competencies, develop
strategies for meeting the student’s
needs in the following quarter and
The first tenets of TCM evolved and
proliferated through out the world and
over many centuries. This has lead to
the development of many subsystems,
which are loosely described as Asian or
Eastern medicine. As a matter of fact,
the refinement of TCM was also
initiated in Europe as well as Asian
countries and most recently in the
United States.
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proceeds. Although not all of any term’s
check-offs must necessarily to be
completed in the term, students will be
given a grade of Partial Competency if
they drop substantially behind the
baseline for their year or quarter.
review their progress. The clinic
supervisor will sign off for the
competencies they have observed.
There are separate competencies for
each observation and clinic intern shift.
In general, the information tracked by
the Registrar’s Office regarding patient
numbers, shifts, interim and preceptor
hours is not included in these
competencies. Students will continue to
meet with the Registrar’s Office and
receive written feedback detailing their
progress. The purpose of these Learning
Objectives is to evaluate the clinician’s
performance of skills required of
acupuncturists, including medical
interviewing, physical exams, diagnosis,
referral and assessment, therapeutics and
communication skills. Clinicians are
encouraged to complete competencies
and have them signed off as the term
During a student’s clinical education the
following must be completed:
AOM OBSERVATION
OBJECTIVES
Clean Needle Technique (NCCA) Exam
Clinical Competency One
Clinical Intern Exam
Written
Practical
Preceptorship
AOM INTERNSHIP OBJECTIVES
Acupuncture Intern B Completion
Clinical Competencies Two-Six
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Figure 6 AOM Clinical Competency One
Observation I, II, and III
Student Name:
Quarter/Year:
Learning Objectives:
Active observation in patient visits
Familiarity with all aspects of clinic operation
Review and practice of the four exams
Supervisor/Initial/Date Objective
Is familiar with and adheres to clinic policy, procedure and
flow. Knows procedure for biohazard disposal and CNT.
Demonstrates ability to anticipate needed paperwork and have
it completed and ready.
Has demonstrated the ability to be part of a health care team
by actively observing and participating in patient care and
follow-up, specifically contributing to the therapeutic protocol
being developed by the supervisor and primary clinician.
Actively contributing to the diagnosis and case discussions
must also be demonstrated.
Has demonstrated the ability to properly fill out the dispensary
Plan and Instruction Sheet during discussion with Shift
Supervisor and primary clinician.
Has ensured that the exam room is adequately stocked with
items needed during the shift.
Has a current Health Care provider's card.
Has passed the NCCA Clean Needle Technique course.
Has watched the Blood Borne Pathogen Video, and is familiar
with OSHA requirements.
Is familiar with emergency procedures.
Has discussed the above guidelines and met with clinic
supervisor to review and set goals.
Has passed written Clinic Intern Entry Exam
Demonstrates proper understanding of basic skills and
techniques during practical portion.
Conveys TCM and Western medical information to their
patients, supervisors, and colleagues.
Has documentation of annual TB test (done at no charge at
BCNN) or appropriate follow-up to previous positive test
result.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Figure 7 AOM Clinical Competency Two
Internship I, II, III, IV and V
Student Name:
Quarter/Year:
Learning Objectives:
Demonstrates self-reliance and thoroughness in performing the four exams.
Chart properly and completely in the SOAP format.
Contribute actively to the diagnostic and therapeutic work up of a client.
Demonstrate competence performing critical technique skills.
Supervisor/Initial/Date Objective
Demonstrates the ability to chart 2 complete patient histories.
Demonstrates the ability to safely and effectively perform and
record the 4 exams.
Has contributed to case discussions, pattern differentiation,
diagnosis and therapeutic plan.
Facilitates time management by anticipating needed
paperwork and ensuring adequate room stock.
Demonstrates the ability to choose correct needle gauges and
sizes most appropriate for the particular patient, condition and
therapeutic goal.
Demonstrates the ability to perform all the following
techniques in a safe, competent manner:
• Needle insertion with tube
• Needle withdrawal
• Six methods of attaining Qi
• Reinforcing
• Reducing
• Fixed cupping
• Running cupping
• Indirect moxibustion
• Rice grain direct moxibustion
• Warm needle
• 5-Needle Auricular
• Tui-Na
• Needle Aishi point
Selection, set up and proper placement and monitoring of
electroacupuncture
Discussed the above guidelines and met with clinical
supervisor to review and set goals for quarter.
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Student Name:
Quarter/Year:
Supervisor Initial/Date Objective
The Acupuncture Intern B (AIB) will perform a minimum of
100 total treatments, including a minimum of 20 first patient
interactions (FPI) and 80 subsequent patient interactions (SPI)
over a minimum a 3 academic quarters and 5 clinic shifts.
The AIB will meet with the AOM Clinic Director upon
completion of all Clinical Competency Two Objectives to
determine advancement to Acupuncture Intern A (AIA).
Has documentation of annual TB test (done at no charge at
BCNH) or appropriate follow-up to previous positive test
result.
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AOM CLINICAL TRAINING – LEARNING OBJECTIVES
Figure 8 AOM Clinical Competency Three
Clinical Competency Three
Internship VI, VII, VIII
Student Name:
Quarter/Year:
Learning Objectives:
1. To expand knowledge and skills in pattern differentiation, diagnosis, 4 exams,
charting of therapeutic plan and rationale.
2. Be able to formulate treatment programs using Acupuncture, Nutrition, Tui Na, Qi
Gong, and Auriculotherapy.
3. To demonstrate and communicate a preventive view of health assessment to a
patient using TCM concepts.
4. To assume the role of Acupuncture Intern A.
Supervisor Objective
Initial/Date
Has demonstrated the ability to chart the patient’s history competently and
completely with adequate communication skills and thoroughness. Can
use the appropriate forms for FOC, in-house referrals, and return visits and
is able to put these in the proper order in the chart. Can translate, in their
charting, what they perceive via inspection, auscultation and olfaction,
history-taking, and palpation in accordance with TCM theory.
• Establish professional boundaries that maintain compassionate
professionalism while avoiding over-familiarity.
• Exhibit professional behavior in medical ethics, professional ethics,
personal boundaries, proper communication, behavior and dress.
• Exemplify personal health and wellness.
Demonstrates the ability to perform the following exams within the time
allotted.
4 Exams (FOC in 30 minutes)
Front Mu and Back Shu analysis in 15 minutes (or equivalent exam per
supervisor)
Auricular Point assessment in 10 minutes
Listen, observe and palpate the patient properly and use TCM theory to
make appropriate diagnoses.
Has formulated a treatment plan including the use of:
• Acupuncture
• Nutrition (TCM focus)
• Tui Na
• Qi Gong
• Life Style Counseling
• Auriculotherapy
(continued on next page)
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Student Name:
Quarter/Year:
Supervisor Objective
Initial/Date
Has discussed the above guidelines and met with clinic supervisor to
review and set goals.
Additional goals/concerns:
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Figure 9 AOM Clinical Competency Four
Internship IX, X, XI
Student Name:
Quarter/Year:
Learning Objectives:
1. To improve interviewing and communication skills.
2. To integrate a wellness approach in the context of TCM
3. To be able to develop a treatment plan for 6 cases with follow-up/outcome from the
list of conditions shown in Clinical Competency Seven.
Supervisor Objective
Initial/Date
Is able to establish and maintain rapport and communicate professionally
with patients as observed by clinic supervisor.
Demonstrates the capacity to prioritize patient’s health concerns and
discuss general treatment strategies with the patient and clinic supervisor.
Demonstrate ability to access research information and to critically assess
the value of published clinical research in the field.
Has demonstrated the ability to perform and complete all techniques listed
in Clinical competency Two.
Re-certify CPR status.
Has formulated a treatment plan including the use of:
[For six conditions listed in Clinical Competency Seven]
Acupuncture
Nutrition (TCM focus)
Tui Na
Qi Gong
Auriculotherapy
Performed a follow up series for each of these cases (3 treatment
minimum) and can report on outcome:
Case A:
Case B:
Case C:
Case D:
Has presented a case in case review following the SOAP/outcome format.
Has discussed the above guidelines and met with clinic supervisor to
review and set goals.
Additional goals/concerns:
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Figure 10 AOM Clinical Competency Five
Internship XII and XIII
Student Name:
Quarter/Year:
Learning Objectives:
1. To achieve competency in all basic acupuncture skills.
2. Demonstrate basic skills in pattern discrimination and diagnosis.
3. To demonstrate a basic use of TCM therapeutics.
4. To demonstrate good overall patient management ability.
Supervisor Objective
Initial/Date
Has continued to demonstrate the ability to perform competently all
acupuncture techniques listed in Clinical competency two.
Has demonstrated good time management skills completing SPI in 60
minutes and FPI in 90 minutes.
Articulate the underlying pathophysiology of applied TCM
Exhibit familiarity with Chinese medical classics and use the classical
principles and teachings in their TCM skill.
Utilize the rich heritage of traditional Chinese medicine and treat it as the
guiding force in diagnosis and treatment.
Students will be immersed in, and infused with, the holistic concepts
embodied within TCM theory.
Demonstrates the ability to gather pertinent information, perform the 4
exams, synthesize a diagnosis and devise, implement and monitor a
treatment plan for patients. The clinic supervisor will have worked with
the clinician on 5 different cases:
Case A:
Case B:
Case C:
Case D:
Case E:
Demonstrates the ability to recognize and implement (with follow-up) 5
cases for referral.
Has discussed the above guidelines and met with clinic supervisor to
review and set goals.
Has discussed and demonstrated skills required for operating at TCM
practice.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Figure 11 AOM Clinical Competency Six
Internship XIV
Student Name:
Quarter/Year:
Learning Objectives:
1. To consolidate clinical skills
2. Demonstrate basic skills in pattern discrimination and diagnosis.
3. To demonstrate a basic use of TCM therapeutics.
4. To demonstrate good overall patient management ability.
Supervisor Objective
Initial/Date
Has demonstrated the ability to perform and evaluate all remaining
examinations.
Has continued to demonstrate good time management in all situations
including acute illness.
Has demonstrated successful ability to write a referral letter to another
practitioner.
Has shown initiative in seeing the need to call a patient to follow up/check
in, after receiving permission from the clinic supervisor.
Listening and intuitive skills: Transfer intuition into their TCM techniques
Demonstrates continued expansion of abilities with regard to gathering
information, synthesizing a diagnosis, and has developed treatment plans
for 5 different cases. Has seen these patients since the initial protocol,
made adjustments as needed, and has discussed long term goals with the
patient and clinic supervisor:
Document the effects of any applied modality to determine and predict
therapeutic outcome.
Case A:
Case B:
Case C:
Case D:
Case E:
Demonstrates good therapeutic integration as evidenced by therapeutic
plans that consistently integrate different TCM modalities and reflect some
aspect of wellness care. Provide health prevention measures based upon
traditional Chinese medicine (such as Tai Chi, Qi Gong, and dietary
guidelines) to support the well-being of their patients.
Has discussed and demonstrated skills required for operating a TCM
practice.
Additional Goals/Concerns:
Has documentation of annual TB test (done at no charge at BCNH) or
appropriate follow-up to previous positive test results.
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AOM CLINICAL TRAINING – LEARNING OBJECTIVES
Figure 12 AOM Clinical Competency Seven
Categories of Disease/Conditions for Therapeutic Plans
Student Name:
Quarter/Year:
Categories of Western disease/conditions for which TCM therapeutic plans are to be
developed (Competency Four). The plan should include at least one series of three return
visits as well as a plan for long-term management if appropriate. Students should attempt
to see the full list of disease/conditions signing off as they proceed.
Supervisor Disease/Condition
Initial/Date
Cough and Asthma
Insomnia
Headache
Common Skin Disorder
Low Back Pain
Anxiety/Stress
Nicotine Addiction
Fatigue
Cold/Flu
Sinusitis/Rhinitis
Diarrhea
Constipation
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and other factors. Since total health also
includes spiritual health, naturopathic
physicians encourage individuals to
pursue their personal spiritual path.
ND CLINICAL COMPETENCIES
PRINCIPLES OF NATUROPATHIC
MEDICINE
Prevention Naturopathic physicians
emphasize the prevention of disease,
assessing the risk factors and hereditary
susceptibility to disease and making
appropriate interventions to prevent
illness. Naturopathic Medicine strives to
create a healthy world in which
humanity may thrive.
The Healing Power of Nature [Vis
Medicatrix Naturae] Naturopathic
medicine recognizes an inherent ability
in the body which is ordered and
intelligent. Naturopathic physicians act
to identify and remove obstacles to
recovery and to facilitate and augment
this healing ability.
Wellness Naturopathic medicine seeks
to establish and maintain optimum
health and balance, wellness is a state of
being healthy, characterized by positive
emotion, thought and action. Wellness
is inherent in everyone, no matter what
dis-ease(s) is/are being experienced. If
Wellness is really recognized and
experienced by an individual, it will
more quickly heal a given dis-ease than
direct treatment of the dis-ease alone.
(This principle was adopted by Bastyr
University and added to the six
principles.)
Identify and Treat the Causes [Tolle
Causam] The naturopathic physician
seeks to identify and remove the
underlying causes of illness, rather than
to eliminate or merely suppress
symptoms.
First Do No Harm [Primum Non
Nocere] Naturopathic Medicine follows
three principles to avoid harming the
patient: 1) utilize methods and medicinal
substances which minimize the risk of
harmful side-effects; 2) avoid, when
possible, the harmful suppression of
symptoms; 3) acknowledge and respect
the individual’s healing process, using
the least force necessary to diagnose and
treat illness.
Doctor as Teacher [Docere]
Naturopathic physicians educate the
patient and encourage self-responsibility
for health. They also acknowledge the
therapeutic value inherent in the doctor patient relationship.
Treat the Whole Person Naturopathic
physicians treat each individual by
taking into account physical, mental,
emotional, genetic, environmental, social
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CLINICAL COMPETENCIES –
NATUROPATHIC MEDICINE
Quarter 3
Chart properly and completely in the
SOAP format.
Contribute actively to diagnostic and
therapeutic work-up of patient cases.
Begin, at supervisor's discretion, limited
primary work.
Mission Statement:
To train naturopathic physicians who are
imbued with an understanding of how to
clinically apply the healing power of
nature and the principles of Naturopathic
Medicine.
LEARNING OBJECTIVES FOR
PRIMARY CLINICIANS
LEARNING OBJECTIVES FOR
SECONDARY CLINICIANS
Quarter 4 and 5
Expand knowledge and skills in the
interview, PE, differential diagnosis,
treatment and charting.
To formulate basic plans utilizing
nutrition, homeopathy, counseling,
botanical medicine and physical
medicine and explain the rationale for
each item in plan to the supervising
physician and the patient.
Each student clinician during his/her
career at the Bastyr Center for Natural
Health demonstrates competency at
numerous clinical skills. One way of
keeping track of the progressively
expanding expertise of a student
clinician is by a system of
skills/performance evaluations designed
to be completed sequentially by term.
The following is a time line for all ND
student clinicians. After each term is
completed, the student will receive
written feedback or will meet with their
clinic supervisor to discuss how well
they have completed their shift
competencies, develop strategies for
meeting the student’s needs in the
following quarter and review their
progress. The clinic supervisor will sign
off for the competencies they have
observed.
Quarter 6
Suggest probable etiologies underlying a
particular diagnosis.
To demonstrate and communicate a
preventive view of health assessment to
a patient.
Quarter 7 and 8
To demonstrate good overall patient
management ability.
To develop holistic therapeutic plans and
long term case management plans.
To develop the ability to function
independently during follow up visits,
developing treatment plans with minimal
assistance from the supervising doctor.
Quarter 1
Active observation during patient visits.
Familiarity with all aspects of clinic
operation.
ND CLINICAL
COMPETENCIES
Quarter 2
Review and practice of history and PE
skills.
Present cases at preview and review.
During your clinical training at the
Bastyr Center for Natural Health, you
are required to demonstrate competency
with numerous clinical skills. Those
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skills begin with the secondary skills and
advance to the primary skills, each
building upon the next.
The competencies are listed on the
sheets following this introduction. You
must have each sheet signed off by your
supervising physician, keep a copy for
yourself and turn the original in to the
clinic registration staff to prove
completion. Following, you will find the
clinical competencies for secondary
clinicians and primary clinicians and the
timelines we suggest you follow in order
to complete them in time for graduation.
off competency does not assure a
grade of AC on any clinic shift.
All secondary competencies must be
signed off before a clinician may
advance to primary status. All primary
competencies must be signed off before a
primary may graduate.
Clinical competencies #1, quarters 1-3,
Secondary Clinicians
Clinical competencies # 5 – Physical
Medicine Secondary Competencies
Clinical competencies # 7 – Counseling
Clinical competencies # 8 – Dispensary
Note: The clinical competencies listed in
this section are numbered for your
convenience and ease of tracking. The
numbers are not significant in any other
way; they are simply there to help you
keep track of which competencies you
have fulfilled and which ones you still
need to attend to.
Secondary Clinicians
All primary clinicians must demonstrate
competency in performing all physical
exams and in diagnosis and treatment of
a list of conditions. Following this
condition you will find a sign off sheet
for the exams, lists of steps to be
included in the exams and the sign off
sheet for the conditions.
Primary Clinicians
Clinical competencies #2, quarters 4-8,
Primary Clinicians
Clinical competencies #3 - Conditions
Clinical competencies #4 – Physical
Examinations
Clinical competencies #6 - Physical
Medicine Primary Competencies
Elective competencies – # 9
Homeopathy, #10 Visceral Manipulation
These competencies are not linked to
the clinic shift grades. They are a
separate requirement, and a signed-
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1. ND SECONDARY CLINICAL COMPETENCIES
Student Name:
Quarter/Year:
Figure 13 ND Secondary Clinical Competencies
Competency
Quarter 1
Student
Supervisor
Signature/
Date
Quarter 2
Comment
Supervisor
Sig/Date
1. Is familiar with
and adheres to clinic
policy, procedures,
and flow. Knows
procedure for
biohazard disposal,
speculums, cervical
cap, diaphragm, ear
lavage equipment.
2. Demonstrates
ability to anticipate
needed paperwork
and have it
completed/ready: lab
forms for Pap’s, lab
requisition forms,
release of records
form, diet diaries, and
is able to find specific
protocols for patients
upon request.
3. Demonstrates the
ability to be part of a
health care team by
actively observing
and participating in
patient care and
follow up, specifically
contributing to the
therapeutic protocol
being developed by
the supervisor and
primary clinician, and
contributing to the
differential diagnoses
or problem list in case
discussion
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Comments
Supervisor
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Competency
Quarter 1
Student
Supervisor
Signature/
Date
Quarter 2
Comment
Supervisor
Sig/Date
4. Demonstrates the
ability to properly fill
out the dispensary
plan and instruction
sheet during
discussion with the
supervising doctor
and primary clinician.
5. Ensure the exam
room is adequately
stocked with items
needed during the
shift.
6. Has a current CPR
card/Emergency
responder card.
7. Demonstrates an
understanding of how
to integrate the
traditional modalities
of naturopathic
medicine (herbology,
physiotherapy,
hydrotherapy,
nutrition,
homeopathy, life style
modifications) into
general treatment
plans
8. Demonstrates an
understanding of the
principles and
heritage of
naturopathic
medicine.
9. Understands and
applies the therapeutic
order in the care of
patients.
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Comments
Supervisor
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Competency
Quarter 1
Student
Supervisor
Signature/
Date
Quarter 2
Comment
Supervisor
Sig/Date
10. Is familiar with
emergency
procedures manual
and knows the
location of the
emergency box and
oxygen tank and how
to use the contents.
11. Demonstrates the
ability to present the
appropriate
information at case
preview and case
review in SOAP
format and utilizing
appropriate medical
terminology.
12. Able to assess and
identify
pertinent/relevant
patient findings and
life style
modifications.
13. Demonstrates
communication skills,
which emphasize
patient needs and are
sensitive to patient
lifestyle, gender,
culture, and
socioeconomic status.
14. Reads charts and
prepares for patient’s
visits prior to case
review.
15. Demonstrates the
ability to chart and
complete patient
visits in SOAP
format.
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Comments
Supervisor
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Competency
Quarter 1
Student
Supervisor
Signature/
Date
Quarter 2
Comment
Supervisor
Sig/Date
16. Is able to explain
lab requirements to a
patient, including the
purpose of the test
specimen collection
technique, any dietary
modification required,
and anticipated length
of time before results
are available, and
associated billing
specifications.
17. Has
documentation of
annual TB test (done
at no charge at
BCNH) or
appropriate follow-up
to previous positive
test result
167
Quarter 3
Comments
Supervisor
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
2. ND PRIMARY CLINICAL COMPETENCIES
Student Name:
Quarter/Year:
Figure 14 ND Primary Clinical Competencies
Competency
Quarter
4/5
Sup
Sig/Date
Quarter
6/7
Comment
Sup
Sig/Date
1. Demonstrates the
ability to chart
competently in SOAP
format. Complete the
patient's history with
adequate
communication skills
and thoroughness, uses
appropriate forms for
FOC and in house
referrals, and puts in
proper order in the chart.
Possesses Charting
Skills
Chart chief complaint
focused with 7 attributes
and detailed description
of symptoms.
Utilize SOAP format.
Use proper terminology
and medical language.
Properly discuss the role
and the application of
the principles of
naturopathic medicine in
writing including
assessment and
rationale.
Chart legibly with
grammatically correct
summaries of the patient
visit.
Demonstrate an ability
to complete all clinical
forms accurately.
2. Demonstrates the
ability to perform a
whole person analysis
for health and risk
factors.
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168
Quarter
8
Comments
Sup
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
Student Name:
Competency
Quarter/Year:
Quarter
4/5
Sup
Sig/Date
Quarter Quarter
6/7
8
Comments Sup
Sig/Date
3. Listens to the
patient’s narrative and
always tries to
understand the root
cause of each patient’s
condition.
4. Incorporates the
Naturopathic Principles
into the patient
interview.
5. Is able to establish
and maintain rapport
and to communicate
professionally with
patients as observed by
supervising doctor.
6. Understands medical
information and shares
that information with
patients in terms that
they can understand.
7. Demonstrates the
capacity to prioritize
patients’ health
concerns, including the
need for referral and
treatment strategies,
with the patient and
supervising doctor.
8. Presents all
considered medical
interventions with
respect to cost/benefit
analysis.
9. Demonstrates the
capacity to do
appropriate lifestyle
counseling including
Safer Sex.
(continued on next page)
169
Comments
Sup
Sig/Date
Comments
Student Clinician Handbook, 2003-2004
Student Name:
Competency
Quarter/Year:
Quarter
4/5
Sup
Sig/Date
Comments
10. Demonstrates an
ability to conduct
medical research using
printed and electronic
sources and
demonstrates familiarity
with medical journals
and standard textbooks.
11. Determines and
conducts appropriate
physical exams and
conveys the clinical
relevance of these exams
to supervising doctor.
12. Possesses sufficient
knowledge of the safety
of every treatment
prescribed.
13. Tracks the effects of
applied interventions.
14. Recertified CPR
status (current CPR)
15. Has documentation
of annual TB test (done
at no charge at BCNH)
or appropriate follow-up
to previous positive test
result.
16. Has presented in
case review following
the SOAP/outcome
format.
17. Has demonstrated
good time management
skills, completing a
ROC in 45 minutes and
a FOC in 75 minutes.
18. Has demonstrated
B-12 intramuscular
injection
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170
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Student Name:
Competency
Quarter/Year:
Quarter
4/5
Supervisor
Sig/Date
Quarter
6/7
Comment
Supervisor
Sig/Date
19. Has demonstrated
successful ability to
write a referral letter to
another physician
specialist.
20.Has demonstrated
ability to write a
treatment summary
letter to referring
physician (patient’s
primary care
physician).
21. Has shown
initiative in seeing the
need to call a patient to
check in after receiving
permission from the
supervising doctor.
22. Has completed
transfer of assigned
patients to secondary
student clinicians
during the last patient
care shift.
23. Has completed 1
chart summary for a
clinic patient with
multiple visits (8-10)
over at least a 1-year
period.
24. Has fit either a
cervical cap or
diaphragm on a patient
or student model.
25. Has demonstrated
initiative in researching
patient cases.
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171
Quarter
8
Comment
Supervisor
Sig/Date
Comment
Student Clinician Handbook, 2003-2004
Student Name:
Competency
Quarter/Year:
Quarter
4/5
Supervisor
Sig/Date
Quarter
6/7
Comment
Supervisor
Sig/Date
26. Demonstrates
competency in
interpreting findings
from laboratory,
radiographic and other
tests.
27. Demonstrates
initiative and
competency in
determining relevant
additional diagnostic
testing.
28. Develops trust in
their intuitive knowing
and demonstrates the
ability to articulate and
incorporate their
intuitive process into
the decision-making of
clinical management.
29. Effectively utilizes
and integrates multiple
methodologies and/or
modalities within the
care of any particular
patient.
30. Demonstrates
competency in
assessing probable
etiology and processes
underlying diagnoses
in discussion and in
charting.
31. Understands and
models appropriate
professionalism in the
context of intimate
modalities and
conversations.
32. Acts within ethical
parameters.
33. Understands and
appreciates personal
health and wellness.
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172
Quarter
8
Comment
Supervisor
Sig/Date
Comment
Student Clinician Handbook, 2003-2004
Student Name:
Competency
Quarter/Year:
Quarter
4/5
Supervisor
Sig/Date
Quarter
6/7
Comment
Supervisor
Sig/Date
34. Understands CPT
and ICD-9 coding and
demonstrates this
knowledge in billing
and charting.
35. Demonstrates an
understanding of
naturopathic and
professional
organizations and their
function in the
profession.
173
Quarter
8
Comment
Supervisor
Sig/Date
Comment
Student Clinician Handbook, 2003-2004
3. ND PRIMARY CLINICAL COMPETENCIES - CONDITIONS
Student Name:
Quarter/Year:
Figure 15 ND Primary Clinical Competencies - Conditions
Categories of disease/conditions for which holistic therapeutic plans are to be developed
beginning with clinical competency four. The therapeutic plan should include at least 1 follow
up visit as well as future plan indicating long-term management goals. To fulfill competency,
each student must demonstrate an understanding of pathology, differential diagnosis,
conventional treatments and naturopathic treatment options.
Supervisor
Initial/Date
Competency
Cardiovascular disease: e.g. HTN, hypercholesterolemia, coronary artery disease,
angina, etc.
Dysglycemia: e.g. diabetes or hypoglycemia
Food Allergies/Intolerances
Upper gastrointestinal disorder: e.g. GER, GERD, PUD, dyspepsia
Lower gastrointestinal disorder: e.g. IBD, IBS, Crohn’s, UC, constipation, diarrhea
Hepatobiliary disease: e.g. cholelithiasis, hepatitis, metabolic liver disease
Cancer prevention and/or treatment
Skin diseases
Arthritis or myalgia (long term)
Anemia
Osteoporosis or osteopenia
Gynecological conditions: e.g. FBD, menopausal management/PMS or
dysmenorrhea, endometriosis, polycystic ovary disease, management of abnormal pap
smear
Male genitourinary conditions: e.g. prostate disorder, epididymitis, varicocele
Acute Respiratory Tract Disorder: e.g. otitis media, strep throat
Chronic Upper Respiratory Tract Disorder
Asthma
Nutritional deficiencies
Urinary tract and/or kidney disorders: e.g. UTI, pyelonephritis, glomerulonephritis
Mental/emotional illness
Nervous system disorder: e.g. insomnia, dizziness, seizure
HIV: e.g. opportunistic infections associated with HIV+, also HIV risk assessment
Endocrine disorders
Musculoskeletal conditions - acute
Musculoskeletal conditions - chronic
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4. ND LIST OF PHYSICAL EXAMS TO BE PERFORMED BY CLINICIANS
Student Name:
Quarter/Year:
Figure 16 ND List of Physical Exams to be Performed by Clinicians
The steps of each exam are listed in the Physical Exam Outline (see page 245). The exams are to
be performed from memory and observed in full by the supervising doctor. Clinicians are
encouraged to complete their exams well in advance of their last patient care shift. A copy of
this page is given to the Clinic registration staff upon completion.
Sup
Initial /
Date
Exam
Gynecological Exam - breast (in 10 minutes)
Gynecological Exam - pelvic (in 20 minutes)
Male Reproductive Exam including prostate (in 20 minutes)
Well Child Check-up including developmental mile-stone assessment (in 20 minutes)
Complete 72 Multistep exam (in 30 minutes) (also referred to as 72-step exam
HEENT Exam
Abdominal Exam
Respiratory Exam
Cardiovascular Exam
Musculoskeletal Exam
Neurological Exam
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5. ND PHYSICAL MEDICINE SECONDARY COMPETENCIES
Student Name:
Quarter/Year:
Figure 17 ND Physical Medicine Secondary Competencies
Mission Statement: To offer specialized care in physical medicine modalities in an atmosphere
of excellence, professionalism and compassion, while simultaneously developing these skills and
attributes in naturopathic medicine student clinicians.
Clinical Competencies:
1.
Demonstrates ability to perform listed hydrotherapy treatments
2.
Demonstrates ability to perform listed physiotherapy treatments
3.
Demonstrates soft tissue assessment and treatments
Supervisor/
Initial/Date
Objective
Possesses charting skills focused on chief complaint with full 7 attributes and detailed
recording of symptom presentation in their charting.
Understands and models appropriate professionalism in context of intimate modalities.
Models sensitivity to patients’ comfort level, issues around modesty and physical
touch. Students will establish professional boundaries that maintain compassionate
professionalism while avoiding inappropriate behavior.
Strives to optimize fitness in order to do the physical work required in physical
medicine.
Recognizes the importance of Physical Medicine historically in Naturopathic Medicine
Demonstrates appropriate paperwork, charting and actions regarding receiving and
issuing referrals.
Actively diagnoses each complaint at every visit in order to initiate indicated referrals.
Develops general treatment plans inclusive of Physical Medicine on all Naturopathic
Medicine shifts.
HYDROTHERAPY TREATMENT
Constitutional Hydrotherapy
a. technique
b. primary indications
c. contraindications
Hyperthermia
a. technique
b. primary indications
c. contraindications
Wet Sheet Pack
a. technique
b. primary indications
c. contraindications
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Student Name:
Supervisor
Initial/Date
Quarter/Year:
Objective
Colon Irrigation
a. technique
b. primary indications
c. contraindications
Local Contrast
a. technique
b. primary indications
c. contraindications
Other Office and Home treatments (Heating compress [wet sock], neutral bath,
Epsom salts soak, contrast showers, other contrast applications)
a. technique
b. primary indications
c. contraindications
PHYSIOTHERAPY
Diathermy
a. technique
b. primary indications
c. contraindications
Ultrasound
a. technique
b. primary indications
c. contraindications
Low Volt EMS
a. technique
b. primary indications
c. contraindications
Interferential
a. technique
b. primary indications
c. contraindications
Galvanic/Iontophoresis
a. technique
b. primary indications
c. contraindications
Manual Therapy
Soft Tissue Assessment
a. tissue texture evaluation
b. muscle tension evaluation
(continued on next page)
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Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Supervisor Objective
Initial/Date
c. active/passive joint range of motion
Local Tissue Release Techniques
a. NMT
b. Swedish massage techniques
c. cross fiber
d. positional release
Muscle Energy Stretching Technique
a. lower extremity/low back
b. upper extremity/neck/shoulders
a. lower extremity/low back
b. upper extremity/neck/shoulders
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6. ND PHYSICAL MEDICINE PRIMARY COMPETENCIES
Student Name:
Quarter/Year:
Figure 18 ND Physical Medicine Primary Competencies
Clinical Competencies:
• Demonstrates use of orthopedic tests
• Demonstrate use of neurological tests
• Demonstrate ability to assess joint dysfunction due to subluxation through motion
palpation
• Demonstrate ability to reach a working diagnosis, prescribe and administer appropriate
treatment including hydrotherapy, physiotherapy, soft tissue manipulation, joint
manipulation, nutrition, botanicals and homeopathy.
Supervisor
Initial/Date
Objective
Orthopedic Assessment
a. knee
• Ant /Post drawer sign
• Apley’s compression/distraction
• patella femoral grind
• apprehension test for patellar dislocation
• valgus and varus stress test
• McMurray’s test
b. hip/pelvis
• trendelenburg
• test for leg length discrepancy
• Patrick test
c. SI/low back
• straight leg raise
• valsalva
shoulder
• Apley’s scratch test
neck/thoracic outlet
• Adson’s/Reverse Adson’s
• Wright’s test
• Costoclavicular
f. ankle/foot
• anterior draw sign
• tibial torsion test
• dorsiflexion
• Homan’s sign
g. elbow
• lateral epicondylitis
• medial epicondylitis
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Student Clinician Handbook, 2003-2004
Student Name:
Supervisor
Initial/Date
Quarter/Year:
Objective
h. wrist/hand
• phalen’s
• tinel’s sign
Neurological Assessment
a. reflexes
b. Romberg
c. Babinski
d. muscle strength
e. sensation
Joint Fixation Assessment
a. static palpation
b. motion palpation
c. contraindications to joint manipulation (including diseases, medications and
age-related changes)
Appropriate Physical Medicine Prescription/Treatment
a. nutritional support
b. botanical/homeopathic
c. hydrotherapy
d. physiotherapy
e. soft tissue manipulation
f. joint manipulation set up
g. joint manipulation
GENERAL PHYSICAL MEDICINE SKILLS
Has developed palpatory literacy
Has developed confidence to continue care when no diagnosis has been
reached.
Understands and evaluates the effect of interventions on the underlying
pathophysiology.
Possesses awareness of each intervention (details) and, with on-going
experience, comparatively analyzes the interventions producing the most
satisfactory outcomes.
Documents the effects of any applied modality to determine and predict
therapeutic outcome.
CAREER MANAGEMENT
Has developed awareness of costs of therapeutic devices and of their required
upkeep
Learns logistics of room (number, size, type, etc.) needed for Physical Medicine
practice
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Student Clinician Handbook, 2003-2004
Student Name:
Supervisor
Initial/Date
Quarter/Year:
Objective
Has learned scheduling and time management issues surrounding a Physical
Medicine-based practice.
Has developed a simple, small-scale start-up plan for Physical Medicine
practice within context of general Naturopathic Medicine practice.
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7. ND COUNSELING CLINICAL COMPETENCIES
Student Name:
Quarter/Year:
Figure 19 ND Counseling Clinical Competencies
Mission Statement:
The mission of the Counseling Department is to train naturopathic medical students in
relationship-centered care and help students achieve personal integration.
DURING THE FIRST AND SUBSEQUENT SHIFTS, THE STUDENTS WILL MEET
THE FOLLOWING COMPETENCIES. CRITICAL CLINICAL SKILLS ARE IN
BOLD AND MUST BE SUCCESSFULLY DEMONSTRATED.
Supervisor Objective
Initial/Date
Establish rapport which includes demonstrating counseling
characteristics of:
_________ Congruence
_________ Empathy
Positive regard
And communication skills of
_________ Paraphrasing
_________ Clarifying
_________ Reflecting
Summarizing
Demonstrate an ability to stimulate wellness throughout the healing
process. This includes:
_________ Engaging the healer within
_________ Supporting all aspects of the patient's life
_________ Educating the patient concerning the healing process
_________ Engaging in improving the health of the human community
Encouraging patient to assume responsibility for overall health
Recognize and maintain professional limitations and boundaries,
behaviors and attitudes, which are congruent with a growing sense
of personal maturity, emotional integration, and
personal/professional limitations and boundaries.
Demonstrate the ability to refer out to appropriate mental health
providers:
Write a letter of referral or a narrative treatment summary
Demonstrate ability to utilize “United Way Resource Book” for
referrals.
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Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Supervisor Objective
Initial/Date
Assess, stabilize and treat for crisis interventions and refer as
appropriate, including:
_________ Domestic Violence
_________ Suicide Risk
Child/Elder Abuse
Document Initial Assessment Interview (include etiology,
symptomology, diagnostic impression, dynamic formulation, and
treatment plan).
Conduct and document Mental Status Exam
_________
_________
_________
_________
_________
_________
Demonstrate appropriate charting skills including:
Relevant and thorough case histories
Ongoing notes
CPT Codes
Demonstrate openness to present one’s work for ongoing critique, as
well as an ability to hear and incorporate feedback.
Demonstrate the ability to differentiate and articulate symptoms
from cause.
Recognize indicators of psychological conditions and assess
according to the current DSM and make an appropriate treatment
plan. These conditions include, but are not limited to:
Axis I Clinical Syndromes and V Codes
Axis II Personality Disorders
Axis III Related Medical and Psychological Conditions
Axis IV Psychosocial Stressors
Axis V Global Assessment of Functioning
Demonstrate time management skills
Recognize and stimulate the Vis.
Demonstrate intention, ease, and ownership in directing the
therapeutic process
Articulate specific strategies for self-care within the context of the
counseling shift.
Articulate cultural and spiritual considerations as they relate to patient
wellness.
(continued on next page)
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Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Supervisor Objective
Initial/Date
Demonstrate stress reduction techniques related to lifestyle counseling
including:
_________ Relaxation response
_________ Biofeedback
Visualization
Articulate the therapeutic process (i.e. resulting insight, resolving the
presenting problem, or integration of issues in the patient’s life).
Recognize psychotic and characteristically disturbed patients, determine
when counseling would be effective, whether counseling in each case lies
within the scope of naturopathic medicine, and make an appropriate
psychological or psychiatric referral.
Diagnose chemical dependency, assess the appropriate level of treatment
and develop a treatment plan, which aligns with the principles and scope
of the naturopathic model.
Diagnose eating disorders and other addictive patterns (i.e. gambling,
intoxication, compulsive sexual behavior, OTC’s, smoking) as they
manifest in the patient’s life) and refer for appropriate treatment.
Identify stages of change demonstrated by the patient.
Identify community and internet resources for providers and for patients.
Establish an ongoing therapeutic relationship with a couple.
Assess family functioning and make appropriate family interventions.
Demonstrate comfort and confidence when discussing sexual issues with
patients.
Develop a deeper understanding and appreciation of the nature of the
individual as it influences wellness or illness.
Discuss counseling principles within the context of Naturopathic
Medicine and the Therapeutic Order.
Understand and articulate the grieving cycle as it relates to physical and
emotional loss (i.e. loss of health, loved one, job, etc.).
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8. DISPENSARY CLINICAL COMPETENCIES
Student Name:
Quarter/Year:
Figure 20 Dispensary Clinical Competencies
Secondary student clinicians are required to complete product analyses using the
provided Product Analysis Sheet and submit them to the Product Review Coordinator
(PRC) with whom they will meet quarterly for review and check-offs. Students will
choose from the following list of conditions observed on patient care shifts and then
compare the treatments chosen to two other potential treatments. For example, if you
chose a vitamin supplement, compare that supplement to 2 other vitamin supplements for
the same condition. If a tea/tincture and a supplement, etc. are prescribed, you may
compare products in the two categories. You may only review treatments for a specific
condition once. Above each review table, write the chief complaint, relevant subjective
and objective findings, and assessment. Use the table below to record completion of
product reviews.
Supplement Tea or
Prescription Tincture
Substance
Homeopathy/Bach Topical Tx/
Flower
Suppositories/
Essences/Cell
Essential Oils
Salts
Required #
of Product
Analyses
Required # of
Product
Analyses
Required # of
Product Analyses
Required # of
Product
Analyses
10
Check
PRC
10
Check
PRC
5
5
Check
PRC
Check
PRC
Anxiety
Arthritis
Asthma
Abnormal PAP
Cancer
Cholelithiasis
Constipation
Cough
Depression
Detox
Diabetes
Diarrhea
Dysbiosis
Eczema
Fibrocystic Breast
Headache/Migraine
HIV
Hyperlipidemia
Hypertension
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Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Supplement Tea or
Prescription Tincture
Substance
Homeopathy/Bach Topical Tx/
Flower
Suppositories/
Essences/Cell
Essential Oils
Salts
Required #
of Product
Analyses
Required # of
Product
Analyses
Required # of
Product Analyses
Required # of
Product
Analyses
10
Check
PRC
10
Check
PRC
5
5
Check
PRC
Check
PRC
Hypo/Hyperthyroidism
IBD
Insomnia
Menopause
Musculoskeletal
Sprain/Strain, Acute
Myalgia
Nutritional Deficiency
Osteoporosis
Otitis, Pediatric
Peptic Ulcer
Disease/Esophagitis
Pharyngitis
PMS/Dysmenorrhea
Sinusitis/URI, Acute
UTI
Vaginitis
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Student Clinician Handbook, 2003-2004
Figure 21 Product Analysis Sheet
Student Name___________________________________________
CC:
Date______________
____________________________________________________________________
Relevant subjective findings: __________________________________________________
Relevant objective findings: ___________________________________________________
Assessment(s):
____________________________________________________________
Product
Comparison 1
Supplements
a. Intended
mechanism of action.
b. How are the
actions/effects
beneficial to the
patient?
192
Comparison 2
Student Clinician Handbook, 2003-2004
Product Analysis Sheet
Student Name_________________________________________ Date ________________
CC:
____________________________________________________________________
Relevant subjective findings: __________________________________________________
Relevant objective findings: ___________________________________________________
Assessment(s):
___________________________________________________________
Product
Comparison 1
Teas/Tinctures
a. Intended
mechanism of action.
b. How are the
actions/effects
beneficial to the
patient?
193
Comparison 2
Student Clinician Handbook, 2003-2004
Product Analysis Sheet
Student Name_________________________________________ Date__________________
CC:
____________________________________________________________________
Relevant subjective findings: __________________________________________________
Relevant objective findings: ___________________________________________________
Assessment(s):
Homeopathics,
Bach Flowers,
Cell Salts
a. Intended
mechanism of
action.
____________________________________________________________
Product
Comparison 1
b. How are the
actions/effects
beneficial to the
patient?
c. Dose and
therapeutic
range.
194
Comparison 2
Student Clinician Handbook, 2003-2004
Product Analysis Sheet
Student Name_________________________________________ Date__________________
CC:
____________________________________________________________________
Relevant subjective findings: __________________________________________________
Relevant objective findings: ___________________________________________________
Assessment(s):
____________________________________________________________
Product
Comparison 1
Topicals,
Suppositories,
Essential Oils
a. Intended
mechanism of action.
How are the
actions/effects
beneficial to the
patient?
195
Comparison 2
Student Clinician Handbook, 2003-2004
9. HOMEOPATHY CLINICAL COMPETENCIES (OPTIONAL)
Student Name:
Quarter/Year:
Figure 22 Homeopathy Clinical Competencies (Optional)
Mission Statement
Homeopathy is an integral part of naturopathic medicine and a vital tool used by
naturopathic doctors in healing their patients. Bastyr University is committed to teaching
homeopathy with the highest standards in order to graduate naturopathic doctors who are
competent and skilled in the use of homeopathic medicines.
(Optional—ONLY FOR HOMEOPATHY CLINICIANS)
9A. Requirements to enroll in optional homeopathy specialty shifts
Figure 23 Requirements to enroll in optional homeopathy specialty shifts
Supervisor
Initial/Date
Requirements
To register in the homeopathy shift as a secondary student clinician:
• Complete Homeopathy III. Registration in Homeopathy IV is preferred.
To become primary clinician:
• Satisfactorily fulfill the responsibilities of a secondary clinician (as below) on 2
shifts
• Complete and turn in written analysis on 2 cases that you have observed
• Act as the primary clinician on one office call, which includes taking and
analyzing the case, and writing up the patient’s chart notes
• Be available for case discussion with supervising doctor
• Demonstrate the ability to remain present and receptive to the patient
9B. Homeopathy Clinical Competencies for Secondary Student Clinicians
Figure 24 Homeopathy Clinical Competencies for Secondary Student Clinicians
Supervisor
Initial/Date
Requirements
The following are the same as forgeneral Patient Care Shift:
• Adequate attendance is required, as described in the Student Clinician
Handbook
• Ensure that appropriate paperwork is available for signature, such as dispensary
forms, consent forms, and treatment plans.
• Keep track of patient contacts
• Cooperate with the primary clinician and the supervising doctor
• Participate in the taking of the case – demonstrate active listening and
appropriate questioning.
• Participate in case preview/review – come prepared to review by reading patient
charts.
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Student Name:
Supervisor
Initial/Date
Quarter/Year:
Requirements
The following are unique to Homeopathy Specialty Shift:
• Write down the patient’s case with appropriate homeopathic underlining,
observations, etc. on all patient visits.
• Study the case alone, or with a primary clinician, and be prepared to discuss and
analyze the case with the supervising doctor in case preview/review.
• Demonstrate adequate knowledge and use of the repertory and materia medica
as it applies to the patient symptoms.
• Homeopathic Grand Rounds: All homeopathic student clinicians are required to
attend a minimum of five sessions of Grand Rounds in order to enhance their
clinical case study and analysis experience in Homeopathy. Primary clinicians
may be required to attend Homeopathic Grand Rounds, whenever they have a
case that needs study and analysis beyond the homeopathic clinic office call
procedure.
• All homeopathic clinicians should be able to demonstrate adequate knowledge
and use of the repertory and materia medica as it applies to the patient’s
symptoms.
9C. Homeopathy Clinical Competencies for Primary Student Clinicians
Figure 25 Homeopathy Clinical Competencies for Primary Student Clinicians
Supervisor/
Initial/Date
Competency
The following are the same as for general Patient Care shift:
• Assume responsibility for attendance, charting, and tracking the number of
patient visits
• Keep track of patient contacts and ensure that you have seen an adequate
number of patients.
• Cooperate with secondary clinician and supervising doctor
• Participate in case preview/review
• Adequately chart the patient’s visit in a timely fashion (within 24 hours)
Communication skills:
• Explain homeopathy treatment to the patient in clear, and understandable
terms.
• Instruct patients how to take the medicine appropriately and what to expect
from their treatment
• Discuss with the patient what we expect from them in terms of life-style
habits, making follow-up appointments, when they can phone the clinic, etc.
• Display open, and cooperative communications with peers and with
supervising doctors.
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Student Name:
Supervisor
Initial/Date
Quarter/Year:
Competency
• All students will be held to the highest standards of professional and ethical
behavior. These include: patient confidentiality, personal responsibility,
impartiality, professional accountability and an appropriate understanding and
respect of ethical personal boundaries.
Case taking skills:
• Establish adequate rapport with patient
• Demonstrate proper use of open ended and confirmatory questions, listening
skills and full homeopathic case taking plus review of systems, past medical
history, family medical history, etc.
• Be able to take a full case in a reasonable amount of time
• Demonstrate good charting skills, including underlining and completeness of
information, that is readable and relevant
Case assessment and analysis skills:
• Medical differential diagnosis
• Proper lab and other testing in order to confirm the diagnosis
• Proper physical examinations
• Recognize acute vs. chronic prescribing
• Identify the patient’s complaints from a homeopathic perspective. This
includes the chief complaint, the center of gravity, the etiology, the recognition
of general, particular, and mental/emotional symptoms; the differentiation of
strange, rare, and peculiar symptoms from common symptoms; identification of
the miasmatic basis of the patient’s disease, and an assessment of the strength of
the patient’s Vital Force.
• Demonstrate an adequate knowledge and use of the repertory and materia
medica as it applies to the patient’s symptoms.
• Demonstrate the systematic thought processes of homeopathic assessments:
essence, keynote, totality, etiology, reliable symptoms, etc.
• Demonstrate adequate knowledge of comparative materia medica, and
confirmatory and keynote symptoms, in order to arrive at the proper selection of
the medicine.
• Give rationale for potency selection.
• Give evaluation of prognosis of treatment.
• Document all of the above in chart for each visit.
Follow-up case skills:
• Show initiative and persistence in following up.
• Take follow-up case appropriately and comprehensively.
• Evaluate the action of the remedy within appropriate timelines.
• Demonstrate the ability to effectively communicate with other medical
professionals, and to refer to them when appropriate, in order to ensure optimal
patient care.
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10. ND CLINICAL COMPETENCIES FOR VISCERAL MANIPULATION
Student Name:
Quarter/Year:
Figure 26 ND Clinical Competencies for Visceral Manipulation
(OPTIONAL)
Visceral Manipulation is based on the concept that all of the viscera in the body are
mobile and need to be able to move in an unrestricted fashion in order to allow proper
function. Using gentle manipulative techniques to release restriction, adhesions, etc.
enhance organ function and mobility can be restored. This shift will focus on the GI tract
as a follow up to the seminar taught by Dr. W. Polek in March 2001. That course will
cover the abdominal organs.
Supervisor Objective
Initial/Date
Performs global, general and local listening as part of the
diagnostic process
Evaluate and treat the liver – discern the 3 planes of motility –
know the attachments - manipulate
Ability to access and treat the gall bladder
Evaluate and treat the stomach – identify options of this organ and
what attachments might be restricting its movement – ability to
open pyloric sphincter
Evaluate and treat the small intestine – identify D1, D2, D3 and
root of the mesentery –locate the duodenal/jejunal junction
Evaluate and treat the colon – identify the ileocecal valve,
ascending/descending segments and flexures
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NUTRITION CLINICAL COMPETENCIES
LEARNING OBJECTIVES AND COMPETENCIES FOR SECONDARY CLINICIANS
Student Name:
Quarter/Year:
Figure 27 Nutrition Learning Objectives and Competencies for Secondary Clinicians
Clinic Practicum 1
Objectives
1. Develop familiarity with all aspects of clinic operations.
2. Work as a team for consultation management and nutritional interventions.
3. Extract and summarize critical nutritional information from the medical record
to effectively interview the patient.
4. Actively participates with patient interviews and education.
5. Formulate individualized nutritional plan of care for the patient.
6. Develop effective chart documentation skills.
Objective
Competency
Develop familiarity with all
aspects of clinic operations
Reads Student Clinician Handbook.
Work as a team for
consultation management
and nutrition interventions
Supervisor
Initial/Date
Becomes familiar with chart retrieval
procedures.
Becomes familiar with clinic forms, nutrition
handouts and teaching aids.
Reviews schedule of appointments.
Receives tour of clinic.
Attends preview and review in the ND
department (if available.)
Actively participates in preview and review
during every clinic shift.
With the primary as the lead, effectively
assist with interviewing and providing
individualized nutrition education to the
patient.
Accurately obtains patient weight, height,
and wrist circumference.
Prepares appropriate handouts and teaching
aids for the primary.
Completes team recommendation form,
photocopies for chart, and reviews with the
patient.
Completes the superbill and obtains
supervisor’s signature.
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Student Name:
Quarter/Year:
Objective
Competency
Extract and summarize
critical nutritional
information from the
medical record to
effectively interview the
patient
Accurately reviews patient medical record for
chief complaint, established plan of care (if
available), demographics, anthropometic data,
laboratory data, medications/supplements/herbs,
known allergies.
Participate with patient
interviews and
education.
Formulate individualize
nutritional plan of care
for the patient.
Develop effective chart
documentation skills.
Supervisor
Initial/Date
With the primary as the lead, effectively present
the patient case during preview.
Develops rapport with the patient.
Makes eye contact with the patient.
Communicates in an appropriate and effective
manner with patients, students, supervisors, and
other staff.
With the primary as lead, provide nutrition
education to the patient that is individualized,
culturally appropriate, and within the overall
treatment plan for the patient.
Correctly performs calculations necessary for
the Objective portion of the SOAP note.
With the primary as lead, effectively develops
an individualized nutrition care plan for the
patient that is based on medical record and
interview information.
With the primary as lead, effectively present the
nutrition plan of care for the patient during
review.
Completes a minimum of 5 practice SOAP notes
during the quarter.
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NUTRITION CLINICAL COMPETENCIES
LEARNING OBJECTIVES AND COMPETENCIES FOR PRIMARY CLINICIANS
Student Name:
Quarter/Year:
Figure 28 Nutrition Learning Objectives and Competencies for Primary Clinicians
Clinic Practicum 2 and 3
Objectives
• Develop ability to function independently during patient visits.
• Independently develop nutrition care plans that are individualized and reflect realistic
short-term and long-term goals of the patient.
• Conduct a thorough, timely, and comprehensive nutrition interview.
• Provide individualized nutrition education.
• Develop professional skills when interacting with patients, supervisors, staff, and peers.
• Write competently and completely in chart notes, communications with referring
providers, and patient referrals.
• Demonstrate good overall patient management ability.
Objective
Competency
Develop ability to function
independently during patient
visits.
Utilize time efficiently in preview,
actual counseling appointment time
with patient, and review sessions.
Complete work in a timely and
orderly manner.
Demonstrate the ability to create an
organized approach in treatment
related interviews.
Independently develop nutrition
care plans that are individualized
and reflect realistic short and
long-term goals of the patient.
Individualize nutrition care plans
Incorporate patient’s beliefs, daily life
patterns, and socioeconomic
circumstances into nutrition
recommendations.
Incorporate the rich history of
culturally diverse and traditional diets
into meal planning.
Demonstrate the ability to effectively
comprehend clinical data from the
medical record.
Obtain information needed for a
thorough assessment (weight, diet,
histories, exercise level, medications,
labs, etc.)
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204
Supervisor
Initial/Date
Student Clinician Handbook, 2003-2004
Student Name:
Objective
Conduct a thorough, timely, and
comprehensive nutrition
interview.
Provide individualized nutrition
education.
Quarter/Year:
Competency
Use professional resources (text, food
tables, computer, etc.) appropriately to
complete assessments in a timely
manner.
Complete accurate calculations.
Assess patient’s readiness to learn and
barriers to learning.
Determine need for follow-up
appointments.
Apply nutrition therapies for
disease/health management.
Recommend appropriate nutritional
therapies with specific
recommendations.
Appropriately prioritize patient’s
nutritional concerns.
Determine goals and desired outcomes
in conjunction with the patient.
Maintain control of the session.
Assess and prioritize other concerns
that are not necessarily nutritional.
Effectively probe problem areas in the
patient’s diet and lifestyle.
Integrate new scientific knowledge
into individualized medical nutrition
therapy recommendations to the
patient.
Accurately answer the patient
nutrition questions and concerns.
Select appropriate education materials
for the patient.
Closes session by summarizing goals,
action plans, and answering questions
for the patient.
Present and evaluate nutrition
education classes when applicable (i.e.
Smoking Cessation Program, etc.)
(continued on next page)
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Supervisor
Initial/Date
Student Clinician Handbook, 2003-2004
Student Name:
Quarter/Year:
Objective
Competency
Develop professional skills when
interacting with patients,
supervisors, staff, and peers.
Communicate in an appropriate,
effective and professional manner
when dealing with patients, students,
supervisors, and other staff.
Observe the policies and procedures of
the clinic.
Demonstrate positive work
relationships and attitude.
Demonstrate respect and dignity to
others.
Maintain professional appearance.
Demonstrate initiative.
Maintain punctuality and attendance.
Complete assignments as scheduled.
Work as a team player.
Has documentation of annual TB test
(done at no charge at BCNH) or
appropriate follow-up to precious
positive test result.
Communicate verbally and in writing
to referring practitioners when
appropriate.
TB testing
Write competently and
completely in chart notes,
communications with referring
providers, and patient referrals.
Demonstrate good overall patient
management ability.
Note: this competency appears again
with next objective.
Chart properly and completely in
SOAP format.
Encourage whole foods approach to
meal planning.
Refer patients to other dietetic
professionals when a situation is
beyond one’s level of competency (i.e.
renal, nutrition support, etc.)
Communicate verbally and in writing
to referring practitioners when
appropriate.
Note: this competency appears again
with previous objective.
(continued on next page)
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Supervisor
Initial/Date
Student Clinician Handbook, 2003-2004
Student Name:
Objective
Quarter/Year:
Competency
Supervisor
Initial/Date
Consult other disciplines as
appropriate.
To achieve a grade of AC for the Clinical Practicum 3, primary clinicians must achieve
all of the clinical competencies by the end of their last quarter.
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Student Clinician Handbook, 2003-2004
the end of Spring quarter.
The examination will be three
hours and will consist of
three case studies. Students
will be required to write a
SOAP note for three case
studies (see SOAP template).
Subjective information and
parts of the Objective
information will be provided.
Students will have to
complete the remaining
Objective information, the
Assessment, and Plan
portions of the SOAP note.
Students are responsible for
all information contained in
the clinic protocols standards
for SOAP noting. The
examination will be graded as
pass/fail. The Nutrition
program faculty, including
the Nutrition Clinic
Department Coordinator, will
grade the examinations. All
three case studies must
receive pass grades. If one or
more of the case studies do
not receive a pass grade, an
additional case study, or
studies, must be completed
during final exams week the
following quarter. If, for a
second time, the case study,
or studies, are failed,
additional course work will
be required at the discretion
of the Nutrition Faculty. The
student will receive a
notification letter
approximately two weeks
after the written examination
date of the grade result.
EXIT EXAM FOR GRADUATING
NUTRITION COUNSELING
TRACK STUDENTS
In order to graduate, students must pass
the exit exam, which consists of two
parts:
1. Video Taping – Student
clinicians in their third
quarter must have a FOC or
FOC2 appointment
videotaped and graded by the
shift supervisor. The
videotaped evaluation will be
graded as pass/fail. If the
shift supervisor notes
deficiencies and gives a
failure grade, the videotape
will be independently
evaluated by the Nutrition
Clinic Coordinator or other
designated nutrition faculty
for a second opinion of the
deficiencies. If disagreement
regarding the grade still
exists after the second
evaluation, the Nutrition
Department Chair will
evaluate the videotape. If a
failure grade is received, the
student will have to enroll in
an additional entire quarter of
Clinic Practicum and repeat
the videotaped patient
appointment. The student
will receive a notification
letter approximately two
weeks after the videotaped
appointment of the grade
result.
2. Written Exam – An open
book written examination
will take place once a year at
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Student Clinician Handbook, 2003-2004
A student will not receive their degree
until all requirements are met and the
clinic faculty recommends the student
for their degree.
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CLINICAL FACULTY BY
PROGRAM
ND CLINICAL FACULTY
Following are the naturopathic clinic
faculty. All members are licensed in
Washington State:
Figure 29 Clinical Faculty by Program
AOM CLINICAL FACULTY
Following are the AOM Teaching
Clinical Faculty. All are Washington
State licensed acupuncturists:
ND Core Clinical Faculty
Karim Abdullah, ND
Kevin Conroy, ND
Keith Grieneeks, PhD - Counseling
Mark Groven, ND - Physical Medicine
Clinic Coordinator
Jane Guiltinan, ND - Dean of Clinical
Affairs
John Hibbs, ND - Naturopathic
Department Coordinator
Eric Jones, ND
Richard Mann, ND, Homeopathy
Department Chair
Melissa McClintock, ND
Jana Nalbandian, ND
Andrew Parkinson, ND
Bill Roedel, PhD - Counseling
Jamey Wallace, ND - Interim Medical
Director
AOM Core Clinical Faculty
Qiang Cao, ND, LAc - Acupuncture,
Chinese Herbal Medicine
Terry Courtney, MPH, LAc Acupuncture - Chair, Acupuncture and
Oriental Medicine Program
Wei Yi Ding, RN, LAc - Acupuncture,
Chinese Herbal Medicine
Steve Given, MS, LAc - Acupuncture,
AOM Clinic Department Coordinator
Chongyun Liu, LAc - Acupuncture,
Chinese Herbal Medicine
Yajuan Wang, LAc - Acupuncture,
Chinese Herbal Medicine
Ying Wang, LAc - Acupuncture,
Chinese Herbal Medicine
Andrew McIntyre - Acupuncture,
Chinese Herbal Medicine
ND Adjunct Clinical Faculty
Michelle Antonich, ND
Jill Fresonke, ND
Maryann Ivons, ND
Mark Lamden, ND
Nancy Mercer, ND, Homeopathy
Steve Milkis, ND
Dean Neary, ND
Brian Peters, ND
Kasra Pournadeali, ND
Dirk Powell, ND
AOM Adjunct Clinical Faculty
Benjamin Boonchai Apichai, MS, LAc Acupuncture
James Dowling, MAc, RN, LAc Acupuncture
Matt Ferguson, MS, LAc - Chinese
Herbal Medicine
Todd Hymel, LAc - Acupuncture
Kayo King, LAc – Acupuncture
Tong Lu, LAc - Acupuncture
Yuanming Lu, MS, LAc - Acupuncture,
Chinese Herbal Medicine
Michele Najera, LAc- Acupuncture
Janna Rome, MS, LAc - Acupuncture
Mark Tibeau, LAc – Acupuncture
Angela Tseng, LAc – Acupuncture
Jianli Wang, LAc - Acupuncture
NUTRITION CLINICAL FACULTY
Following are the nutrition clinical
faculty. All members are licensed in
Washington State and are registered
dietitians (RD) with minimum certified
graduate degrees in nutritional sciences.
Nutrition Core Clinical Faculty
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Student Clinician Handbook, 2003-2004
Vacant
Nutrition Adjunct Clinical Faculty
Ann Fittante, MS, RD, CD,CDE*
Jeanne Cullen, MS, RD, CD,CDE*
Suzzanne Myer, MS, RD, CD (core staff
relief)
Beverely Kindblade, MS, RD, CD (core
staff relief)
Scott Murdoch, PhD, RD, CD (core staff
relief)
*CDE=Certified Diabetic Educator, a
specialized credential that requires work
experience and passing a certification
exam.
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Student Clinician Handbook, 2003-2004
5a Secondary Clinician (Clinic
Practicum I)
5b Primary Clinician (Clinic Practicum
II and III)
5c Qualitative Student Clinician Video
5d Student Preceptorship Plan
5e Student’s Self-Evaluation
5f Student Patient Contacts
5g Student Evaluation of Preceptor
5h Preceptor’s Evaluation of Student
Experience and Documentation of
Hours
6 Indexes of Patient Handouts
6a Index of ND Patient Handouts
6b Index of Nutrition Patient Handouts
7 ND Physical Exam Guidelines for
Clinical Competencies
8 Medical Abbreviations
9 Documentation Guidelines for
Evaluation and Management
Services
10 Co-Management: Templates and
etiquette guidelines & referral letters
11 Naturopathic Treatment of
Malignancy Consent Form
APPENDICES
Appendix #
1 Clinic Contract
2 AOM Program China Externship
Application Form
3 Absences/Substitute Form – Student
Clinician
4 Examples of Clinic Evaluation
Forms
4a Student Daily Shift Check-Off
Evaluation Form – Patient Care
4b Secondary Student Evaluation Form
– Patient Care
4c Primary Student Evaluation Form –
ND Patient Care
4d AOM Program Observation
Evaluation
4e AOM Program Internship Evaluation
4f CHM Internship/Observation
Evaluation Form
5 Examples of Student Clinic
Evaluation Forms
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Student Clinician Handbook, 2003-2004
Appendix 1
CLINIC CONTRACT
By signing this document I am verifying that I have thoroughly read and familiarized
myself with the Student Clinician Handbook. I have especially noted the following areas
and made note of the differences in these areas between Academic Classroom Policy and
Procedures and Clinic Policy and Procedures:
CLINIC REGISTRATION PROCESS AND POLICIES
ADD/DROP PROCESS AND DEADLINE POLICIES
PAPERWORK DUE DATES
CLINICAL COMPETENCIES
ALL CONFIDENTIALITY PROCEDURES AND POLICIES
PROFESSIONAL CONDUCT AND CODE OF ETHICS
I will adhere to all confidentiality procedures and policies, knowing that all patient
information, including electronically stored information, is confidential and should never
be removed from the clinic or discussed outside of the clinic.
I understand and agree that I am responsible for knowing, understanding, and following
all the information contained within the Student Clinician Handbook, including all
revisions and updates. I understand that I will be held accountable for following and
adhering to these policies and procedures. I also agree and acknowledge that any
intentional falsification in my clinical competency, documentation of patient contact
hours and clinic time sheets is cause for denial of all related clinic hours and may lead to
additional disciplinary sanctions.
Signed ____________________________________
Dated ______________
Printed name____________________________Degree Program(s)______________
1. GIVE SIGNED COPY TO CLINIC REGISTRATION STAFF FOR FILE BEFORE
ENTERING CLINIC.
2. GIVE SIGNED COPY TO CLINIC ENTRY INSTRUCTOR. THIS IS A
REQUIREMENT TO PASS THE COURSE.
3. PLEASE KEEP A COPY FOR YOUR RECORDS.
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Student Clinician Handbook, 2003-2004
Appendix 2
AOM PROGRAM CHINA EXTERNSHIP APPLICATION FORM
Name: _________________________________
Address: _______________________________
Phone:
Emergency Contact While in China
Phone: _________________________________
E-MAIL
___________________________
DESIRED QUARTER FOR CHINA EXTERNSHIP:
_____________________________________________________________________
Please supply the following information:
Copy of latest Clinic Requirement Summary sheet from Clinic registration staff.
Number of credits you expect to take in China
Passport number and date of expiration
A short description of the experience you are hoping for and why you want to go.
How do you plan to pay for this experience?
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Appendix 3
BASTYR CENTER FOR NATURAL HEALTH
ABSENCE/SUBSTITUTE FORM – STUDENT CLINICIAN
It is the responsibility of every Student Clinician to inform both their assigned Supervisor and the Clinic
Program Coordinator (CPC) of any planned absence from the clinic.
Please follow the procedures outlined below:
1. Fill out the bottom portion of this form completely, otherwise it will be returned to you for further
clarification. Fill out a separate form for each shift and planned absence.
2. Notify the Supervisor of each shift you plan to miss, and have him/her sign the appropriate space
below.
3. Primary and Secondary Student Clinicians must obtain a Substitute for each shift you plan to miss,
and have the Substitute sign the appropriate space below.
4. Once the form has been completed, submit it to the CPC. The form will be retained on a Quarterly
basis.
5. All of these procedures must be followed in advance of the Planned Absence. If you are ill or
have a personal emergency, then instead of using this form, you must call the EMERGENCY
LEAVE LINE at 206-834-4189.
6. An unexcused absence will result in an automatic fail for the Quarter.
NAME OF STUDENT: _____________________________________________________________
TODAY’S DATE: _______________ DATE OF EXPECTED ABSENCE: ______________
CIRCLE APPROPRIATE ONE:
NATUROPATHIC PATIENT CARE
HOMEOPATHY
NUTRITION
COUNSELING
DISPENSARY ACUPUNCTURE/ORIENTAL MEDICINE PHYSICAL MEDICINE LAB
SHIFT: (Circle)
MORNING
AFTERNOON
EVENING
REASON FOR ABSENCE:
______________________________________________________________________________________
______________________________________________________________________________________
SIGNATURE OF SUPERVISOR: _________________________________________________
NAME OF SUBSTITUTE: _______________________________________________________
SIGNATURE OF SUBSTITUTE: _________________________________________________
Clinic Program Coordinator
Date
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Appendix 4a
BASTYR CENTER FOR NATURAL HEALTH
STUDENT DAILY SHIFT CHECK-OFF EVALUATION FORM - PATIENT
CARE
STUDENT NAME: _______________________________________
DATE______________
QUARTER/YEAR: _________________________
SHIFT____________________________
NUMBER OF PATIENTS SEEN ON
SHIFT______________________________________
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Supervisor
Objective
Initial/Date
Clinical Skills
Initiative, motivation, responsibility
Communications skills and rapport with patients
Interview skills (S)
Physical exam (O)
Differential diagnosis/assessment skills (A)
Knowledge of naturopathic therapeutics and their proper application
Patient case preparation and follow up
Familiarity with clinic policies and procedures and efficiency in following them
Listening skills
Time management skills
Proper use of lab, diagnostic studies, etc.
Ability to make an appropriate referral when needed and ability to write up
referral
Charting technique (completeness and clarity)
Participation and input in case discussions on shift, case preview and case review
Summary comments: This space for comments/suggestions/recommendations and/or to
explain and
Clarify ratings above: Supervising Clinical Faculty must sign & date
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Appendix 4b
BASTYR CENTER FOR NATURAL HEALTH
SECONDARY STUDENT EVALUATION FORM - PATIENT CARE
STUDENT NAME: _______________________________________
QUARTER/YEAR:
SHIFTS:
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate
(AC)
3 = good
(AC)
4 = excellent
(AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.
*1.
*2.
*3.
*4.
*5.
*6.
*7.
8.
9.
10.
11.
Initiative and responsibility in role as a secondary student clinician:
Cooperation with clinic supervisors and staff:
Familiarity with clinic policies and procedures and efficiency in following them:
Physical exam skills:
Application of academic learning to clinic training:
General overview of case management:
Listening skills:
Communication skills and rapport with peers and supervisors:
Time management skills:
Motivation and initiative in learning clinical skills:
Participation and input in case discussions on shift:
Student’s overall level based on the number of quarters in the clinic: (there are 8 total
quarters):
(please circle the one that is most appropriate)
1
2
3
4
5
6
7
8
Summary Comments: (please write comments to explain and/or clarify your ratings above.
Please Indicate Grade For This Quarter: (circle one)
Failure (F)
In-Progress (IP)
Partial Competency (PC)
(AC)
Supervisor’s Signature
Achieved Competency
Date ___________
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Appendix 4c
BASTYR CENTER FOR NATURAL HEALTH
PRIMARY STUDENT EVALUATION FORM - ND PATIENT CARE
STUDENT NAME___________________________________________________________
QUARTER/YEAR:
SHIFTS_________
___
RATING SCALE: ____
NA = not applicable
1 = unsatisfactory (F)
2 = adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.
Approximate number of patient visits you supervised this student this quarter:
*
*
*
*
*
Initiative and responsibility in patient care:
Communication skills and rapport with patients:
Interviewing skills:
Physical exam skills:
Overall case management skills:
Charting technique (completeness and clarity):
Application of academic learning to clinic training and patient care:
Differential diagnosis/assessment skills:
Knowledge of Naturopathic therapeutics and their proper application:
* Patient follow-up care:
Listening skills:
Time management skills:
Cooperation with clinic supervisors and staff:
Communication skills with peers and supervising doctors:
Motivation and initiative in learning clinical skills:
Familiarity with clinic policies and procedures and efficiency in following them:
Student’s overall level is based on the number of quarters in the clinic: (there are 8 total
quarters):
(please circle the one that is most appropriate)
1
2
3
4
5
6
7
8
Summary Comments: (please write comments to explain and/or clarify your ratings above)
Please Indicate Grade For This Quarter: (circle one)
failure (F)
in-progress (IP)
partial competency (PC)
achieved competency (AC)
Supervisor’s Signature
Date ____________________
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Student Clinician Handbook, 2003-2004
Appendix 4d
BASTYR CENTER FOR NATURAL HEALTH
AOM PROGRAM OBSERVATION EVALUATION
STUDENT NAME:
QUARTER/YEAR: SHIFTS:
The number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate
(AC)
3 = good
(AC)
4 = excellent
(AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Rate each of the following categories and give an overview rating at the end.
Initiative and responsibility in role as Observation Clinician: _______
Cooperation with clinic supervisors and staff: _______
Communication skills with peers and supervisors:
_______
Familiarity with Clinic Policies and procedures and efficiency in following them:_______
Interviewing skills: _______
Time Management Skills:
_______
Charting technique (completeness and clarity): _______
OM Inspection skill and interpretation of tongue diagnosis: _______
OM Auscultation and Olfaction skill: _______
OM Palpation skill and interpretation of pulse diagnosis: _______
Application of academic learning to clinic training: _______
Eight Principles diagnosis skill: _______
Zang-Fu Patterns diagnosis and differention skills:
_______
General overview of case management:
_______
Motivation and initiative in learning clinical skills:
_______
Overall Rating of Clinic Work and Performance for this Quarter:
_______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student
must demonstrate competency ( a 2 or more) on all skills above as well as the overall rating
relative to their current level in the clinic. Please refer to the appropriate clinic competencies
for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)
In Progress (IP) Partial Competency (PC) Achieved Competency (AC)
Supervisors
Signature____________________________________Date_____________________
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Appendix 4e
BASTYR CENTER FOR NATURAL HEALTH
AOM PROGRAM INTERNSHIP EVALUATION
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory
(F)
2 = adequate
(AC)
3 = good
(AC)
4 = excellent
(AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in
all the clinical categories appropriate to her/his status in clinic. A PC grade is given if all critical clinical
skills are successfully demonstrated and one non-critical skill is assessed as unsatisfactory (1 on scale at
left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or
more non-critical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an AC must
accompany the grade. See the Clinic Handbook and grading manual for details.
Skills identified with an * are critical clinical skills, others are essential skills.
Rate each of the following categories and give an overview rating at the end.
1.
*Initiative and responsibility in role as Intern Clinician: _____
2.
*Cooperation with clinic supervisors and staff:
_______
3.
Communication skills with peers and supervisors:
_______
4.
*Communication skills and rapport with patients:
_______
5.
*Interviewing skills:
_______
6.
Time Management Skills: _______
7.
Charting technique (completeness and clarity):
_______
8.
*OM Four Exams skills: _______
9.
*OM Eight Principles Skills:
_______
10.
*Application of acupuncture points location: ___________
11.
Accuracy of acupuncture points location:
_______
12.
Needling techniques:
_______
13.
Moxibustion techniques: _______
14.
Cupping and other techniques:
_______
15.
Clean needle technique: _______
16.
Knowledge of Oriental Medicine therapeutics and their proper application:________
17.
*Patient follow-up care: ________
18.
Familiarity with clinic policies and procedures and efficiency in following them: _______
19.
Appropriate application of Western assessment techniques: ________
20.
Appropriate referral or consideration for referral: ______
Overall Rating of Clinic Work and Performance for this Quarter:
_______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student must
demonstrate competency ( a 2 or more) on all skills above as well as the overall rating relative to their
current level in the clinic. Please refer to the appropriate clinic competencies for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)
In Progress (IP) Partial Competency (PC) Achieved Competency (AC)
_________________________
Supervisor’s Signature
________________
Date
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Student Clinician Handbook, 2003-2004
Appendix 4f
BASTYR CENTER FOR NATURAL HEALTH
CHM INTERNSHIP/OBSERVATION EVALUATION FORM
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate
(AC)
3 = good
(AC)
4 = excellent
(AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Skills identified with an * are critical clinical skills, others are essential skills.
Rate each of the following categories, and then give an overall rating.
1. *Interest and responsibility in patient care: __________
2. *Cooperation with clinic supervisors and other clinicians: _________
3. Communication skills with peers and supervisors: __________
4. *Communication skill and rapport with patient: __________
5. *Interviewing skills: __________
6. *Diagnostic skills and case management: __________
7. Charting technique (completeness, clarify and signature): __________
8. Time management skills: __________
9. *Familiarity with Chinese herbs and basic formulas: __________
10. Knowledge of Chinese Herbal Medicine therapeutics and their proper application:
________
11. *Written clarity of prescriptions and any necessary instructions for packaging herbs:
__________
12. Clear explanation of cooking instructions: __________
*Follow up care with patients: __________
Summary Comments: (please write comments to explain and/or clarify your ratings above.)
Please indicate grade for this Quarter (circle one)
Failure (F)
In Progress (IP)
Partial competency (PC)
___________________________
Achieved Competency (AC)
_____________________
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Supervisor’s signature
Appendix 5A
Date
Nutrition Clinic Evaluation Form
Secondary Clinician (Clinic Practicum I)
Bastyr Center for Natural Health
Student Name _______________ Signature
Nutrition Supervisor Name__________ Signature
Evaluation Date
Quarter
Rating Scale:
NA = Not applicable
1 = Unsatisfactory (F)
2 = Adequate (AC)
3 = Good (AC)
4 = Excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2, 3 or 4
on scale above) in all the clinical categories appropriate to her/his status in clinic. A PC
grade is given if all critical clinical skills are successfully demonstrated and one noncritical skill is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or
more critical clinical skill is assessed as unsatisfactory, or if two or more non-critical
clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in
clinic. If a PC grade is given, a letter detailing requirements for changing the PC to an
AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS identified with an asterisk (*) are critical clinical skills, others are
essential skills.
1. Familiarity with Clinic Operations
Read Student Clinician Handbook
Able to retrieve medical charts
Familiar with clinic forms, nutrition handouts, teaching aids and reference
manual/books.
Comments:
2. Participates with the Care Team*
Actively participates in preview and review every clinic shift
Assists the primary student clinician with interviewing and providing
nutrition education
Comments:
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Student Clinician Handbook, 2003-2004
3. Data Collection*
Reviews the medical record for pertinent patient data
Assists the primary student clinician with presenting the patient case
during preview
Accurately obtains the weight, height, and wrist circumference
of the patient
Comments:
4. Interview and Education*
______
______
______
______
Develops rapport with the patient
Communicates appropriately with patients, students, supervisors, and
other staff
Assists the primary student clinician with obtaining information from the
patient and providing education that is individualized and within the
overall treatment plan for the patient
Assists the primary student clinician in developing an individualized
nutrition care plan based on medical record and interview information
Comments:
5. Documentation*
Completes team recommendation form and reviews it with the patient
Completes the Super Bill
Correctly perform calculations necessary for the SOAP note
Completes a minimum of 5 practice SOAP notes during the quarter
Comments:
6. Professionalism*
Observes the policies and procedures of the facility
Punctuality and attendance
Reliability
Professional appearance
Demonstrates respect and dignity to others
Willing to work as a team player
Accepts constructive criticism
Demonstrates initiative
Assignments completed as scheduled
Demonstrates positive work relationships and attitude
Comments:
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Student Clinician Handbook, 2003-2004
7.
Organization and Time Management*
____Efficient use of time
____Integrates unexpected duties into the work schedule
____Completes working an orderly manner
____Comments
______Overall Evaluation
AC = Achieved Competency (meets or exceeds skill level).
F = Failed (does not meet minimal skill level, student will need to repeat Clinic
Practicum).
IP = In Progress (all work requirements of the Clinic Practicum have not been met by the
end of the quarter).
PC = Partial competency (an aspect of the learning objectives or core competencies have
not been achieved and there is need for further study to earn the required AC).
In your opinion, what are the student’s major strengths and weaknesses?
If the student has received a rating of 1, please specify what is needed to improve and
suggestions as to learning activities that may be used to improve performance.
Additional Comments:
Supervisor Signature____________________
224
Date_____________________
Student Clinician Handbook, 2003-2004
Appendix 5b
Nutrition Clinic Mid-Quarter Evaluation Form
Primary Clinician (Clinic Practicum II and III)
Bastyr Center for Natural Health
Student Name __________
Signature
Nutrition Supervisor Name ____
Signature
Evaluation Date
Quarter
Directions:
Students: Complete a self-critique of your counseling skills and review with your
supervisor.
Supervisors: Complete the evaluation and review with the student.
NA = Not applicable
1 = Unsatisfactory (F)
2 = Adequate (AC)
3 = Good (AC)
4 = Excellent (AC)
1. Nutrition Knowledge
Ability to make specific diet recommendations
Appropriate recommendations for vitamin/mineral supplementation
Comments:
2. Interviewing Skills
Organized approach
Controls interview direction
Effectively probes problem areas in patient’s diet/lifestyle
Comments:
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Student Clinician Handbook, 2003-2004
3. Assessment Skills
Establishes rapport with patients
Appropriately prioritizes patient’s nutrition concerns
Sets goals and desired outcomes in coordination with the patient
Selects appropriate education materials
Provides culturally/economically appropriate diet recommendations
Maintains control of session
Closes session by summarizing goals, action plans, and answering final
questions for the patient.
Comments:
4. Documentation
Concisely and accurately documents counseling session in SOAP note.
Comments:
5. Time Management
Efficient use of time
Comments:
In your opinion, what are the student’s major strengths and weaknesses?
What areas of development does the student need to strengthen during the remainder of
the quarter?
__________________________
Supervisor Signature
______________
Date
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Student Clinician Handbook, 2003-2004
Appendix 5c
Bastyr Center for Natural Health
Nutrition Program
Qualitative Student Clinician Video
Evaluation Form
Circle the number that most closely describes the level of skill:
Skill
Low
A.
Communication
Tone of voice
Clarity
Listening
Rapport
Non-verbal/body language
Note taking does not
interrupt communication flow
High
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
7
7
7
7
7
1
2
3
4
5
6
7
B.
Interviewing
Opening
Establish rapport w/patient
1
2
3
4
5
6
7
Transition to session purpose
1
2
3
4
5
6
7
Identifies session purpose
1
2
3
4
5
6
7
Questioning
Gather appropriate information
in a logical sequence
1
2
3
4
5
6
7
Uses open or closed question
appropriately
1
2
3
4
5
6
7
Uses primary and secondary
questions appropriately
1
2
3
4
5
6
7
Uses leading or neutral
questions appropriately
1
2
3
4
5
6
7
Clinician’s response to the patient information (circle the most common response):
Evaluation
Probing
Hostile Understanding Reassuring
Confrontational
Closing
Shows appreciation
Next steps in appointment
Recap of information given
Asks if any questions
Comments:
1
1
1
1
2
2
2
2
227
3
3
3
3
4
4
4
4
5
5
5
5
6
6
6
6
7
7
7
7
Student Clinician Handbook, 2003-2004
C.
Nutrition Counseling
Awareness – both parties aware of problems, patterns, behaviors
misinformation, and health hx
1
2
3
4
Involves pt in identifying goals
1
2
3
4
Prioritized goals w/pt help
1
2
3
4
Identifies potential barriers
1
2
3
4
Discusses appropriate steps to
achieving goals
1
2
3
4
Information individualized to pt
1
2
3
4
Pt. able to summarize information 1
2
3
4
Discussion of next steps to take
1
2
3
4
Comments:
5
5
5
5
6
6
6
6
7
7
7
7
5
5
5
5
6
6
6
6
7
7
7
7
D.
Overall Evaluation
AC = Achieved Competency (meets or exceeds skill level).
F = Failed (does not meet minimal skill level, student will need to repeat Clinic
Practicum).
IP = In Progress (all work requirements of the Clinic Practicum have not been met by the
end of the quarter).
PC = Partial competency (an aspect of the learning objectives or core competencies have
not been achieved and there is need for further study to earn the required AC).
_________________________
___________________
Supervisor signature
date
228
Student Clinician Handbook, 2003-2004
Appendix 5d
Bastyr University Naturopathic Medicine Preceptorship Program
Student Preceptorship Plan
(To be completed and turned in to Placement Coordinator PRIOR to preceptoring.)
Student (please print):
_______________________________________________________________
Student Area Code/Telephone Number: __________.__________._______________
Expected Graduation (Quarter/Year): ______________________ Class Level (ex. 2nd/4th):
__________
Preceptor’s Name (please print): _________________________________Title: (ND, MD, etc.)
______
Preceptor’s Area Code/Telephone Number: __________.__________.______________
Site Name:
______________________________________________________________________
Address:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Learning Objectives: Please list two to three objectives you wish to accomplish in working
with this preceptor at your chosen site.
Student Signature: _______________________________________________Date:
___________
Placement Coordinator Signature: __________________________________Date:
___________
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Student Clinician Handbook, 2003-2004
Appendix 5e
Bastyr University Naturopathic Medicine Preceptorship Program
Student’s Self-Evaluation
Student (please print): ____________________________________________________________
Dates of Preceptorship: From: _______________________ To: _________________________
5
4
3
2
1
N/A
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Self-Evaluation/Progress Scale:
Excellent, remarkable progress
Above average, substantial progress
Average, some progress
Below average, very little progress
Poor, no progress
Not applicable
Listening skills
Interviewing technique
Physical exam technique
Patient rapport/interaction
Rapport with Preceptor
Diagnostic skills
Case presentation
Time management
Business administration skills
Philosophy of healing
Professional image
Other: (specify) _______________
5
5
5
5
5
5
5
5
5
5
5
5
4
4
4
4
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
In what ways did this experience meet your Learning Objectives? Were there ways in which
your preceptoring experience did not meet your Learning Objectives?
-Student ‘s Evaluation of Preceptor on reverse -
Bastyr University Naturopathic Medicine Preceptorship Program
Student’s Clinical Time Sheet
Student (please print): _____________________________________________________Date: ______________
Preceptor: ________________________________________________________________Title:
____________
Placement Coordinator’s Signature: _______________________________________________Date: _________________
230
Student Clinician Handbook, 2003-2004
Appendix 5f
Student’s Patient Contacts ~ Documentation of ALL Patient Contacts required for credit.
Include your level of participation (Observed, Assisted, or Performed) in each column of
SOAP headings.
(Referencing patient initials is for your documentation only – you do not ask patient to initial form.)
Student Name:
Date
Patient
Initials
Medical Assessment
Preceptor’s
Initials
231
S
O
A
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Student Clinician Handbook, 2003-2004
Appendix 5g
Student Evaluation of Preceptor (ND)
(Confidentiality may be maintained by completing this form after preceptor signs off on
your evaluation.)
Preceptor’s Name (please print): _____________________________________________Title:
________
Preceptor’s Specialty:
_____________________________________________________________
Preceptor Evaluation Scale:
5
Excellent
4
Above average
3
Average
2
Below Average
1
Poor
N/A
Not applicable
A.
B.
C.
D.
E.
F.
G.
H.
I.
Mentoring style
Informative/ability to explain procedures
Patient rapport/support
Clinical skills
Time management
Receptivity to new ideas
5
5
5
5
5
5
Integration of ND philosophy into practice
5
Use of physical modalities
5
Other: (specify) _____________________ 5
4
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Student’s response to preceptor’s teaching style; types of patients seen in practice; modalities
used, etc.
Would you recommend this preceptor to other students? Why or why not?
Student Signature: ____________________________________________ Date: _________
Placement Coordinator Signature: ________________________________ Date: _________
232
Student Clinician Handbook, 2003-2004
Appendix 5h
Bastyr University Naturopathic Medicine Preceptorship Program
Preceptor’s Evaluation of Student Experience and Documentation of Hours
(To be completed and signed by Preceptor)
Student’s Name (please print):
_______________________________________________________
Type of Experience:
______Observational
______Limited hands-on
______Hands-on
Dates of Preceptorship: From: ______________________ To: ______________________
Student Progress Evaluation Scale:
5
Excellent, remarkable progress
4
Above average, substantial progress
3
Average, some progress
2
Below average, very little progress
1
Poor, no progress
N/A
Not Applicable
Basic Skill Presentation
A. Professional appearance
B. Ability to communicate with patients
C. Communication with staff
D. Communication with practitioner
E. Basic diagnostic skills
F. Basic therapeutic skills
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Specific Skills Presentation
Interviewing/health history
Physical exam
Pelvic/breast exam
Lab work-up/interpretation
Hydrotherapy treatment
Manipulation
Physical modalities
Differential diagnosis ability
Application of theories
Public health education
5
5
5
5
5
5
4
4
4
4
4
4
3
3
3
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
N/A
N/A
N/A
N/A
N/A
N/A
5
5
5
5
5
5
5
5
5
5
4
4
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
4
4
4
3
3
3
2
2
2
1
1
1
N/A
N/A
N/A
Specialty in therapeutic area/practice is:
___________________________________________
A. General knowledge/understanding
5
B. Application of specialty knowledge
5
C. Integration of naturopathic medicine
5
233
Student Clinician Handbook, 2003-2004
Preceptor (please print): _______________________________________Title (ND, MD, etc.):
_______
Site Name:
_______________________________________________________________________
Address:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Preceptor comments and/or recommendations for student:
Thank you for serving as a preceptor and for completing this evaluation! Please return
this form to the student or, if you prefer, mail to:
Placement Coordinator
Office of Graduate and Community Medicine, Bastyr Center for Natural Health
1307 North 45th Street, Seattle, Washington, 98103, USA
Telephone: 206.834.4100
TOTAL PRECEPTORING HOURS: _________
TOTAL PATIENT CONTACTS: ________
Preceptor Signature: ____________________________________________ Date:
Student Signature: ______________________________________________ Date:
Placement Coordinator Signature: _________________________________ Date:
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Student Clinician Handbook, 2003-2004
Appendix 6a
Index of ND Patient Handouts

BOTANICAL MEDICINE
 Bach Flower Remedies
 Bach Remedy Personalities
 Garlic
 Ginkgo
 Herbal Insect Repellants
 Hoxsey-Like Tea
 Instructions for Herbal Tea
Infusion/Decoction
 Therapeutic Essential Oils








COUNSELING/STRESS
MANAGEMENT
 Biofeedback
 Biofeedback Procedure Using
Hand-Held Thermometer
 Quit Smoking Protocol
(Counselor’s Notes) (for
practitioner’s use)
 Quit Smoking Protocol—Week 1
 Quit Smoking Protocol—Week 2
 Quit Smoking Protocol—Week 3
 Quit Smoking Protocol—Week 4
 Quit Smoking Protocol—Week 5
 Quit Smoking Protocol—Week 6
 Stress Assessment Questionnaire
 Stress Reduction Techniques

Fasting/Modified Fasting
Detoxification Program: 10-Day
Plan
Five-Day Cleansing Program
Five-System Elimination and
General Detoxification
Health Journal Assessment
Health Maintenance Diet for
Detoxification
Mercury Toxicity and
Detoxification
Mold: Getting Rid of it in Your
Home
Plants That Promote Clean Air
Resources to Detoxify Your
Home Environment
Therapeutic Fasting
FOOD ALLERGY
 Allergy Elimination Diet
 Allergy Elimination Diet Recipes
 Allergy Symptom Survey (for
practitioner’s use)
 Candida Questionnaire (for
practitioner’s and patient’s use)
 Clinical Evaluation of Food
Allergies and Intolerances
 Diet Diary
 Dietary Pulse Survey
 Dr. Gaby’s Allergy Elimination
Diet “A”
 Food Allergy, Intolerance and
Hidden Illness
 Food Intolerance/Sensitivity
Questionnaire
 How to Challenge Foods (From
the Allergy Elimination Diet)
 Instructions for Completing a
Diet Diary
DETOXIFICATION AND
ENVIRONMENTAL ALLERGY
 Allergy Symptom Survey (for
practitioner’s use)
 Candida Questionnaire (for
practitioner’s and patient’s use)
 Clean Drinking Water
 Common Household Pollutants
 Decreasing Home Pollutants
 Detoxification Diet
 Detoxify Your Home
GYNECOLOGY, UROLOGY AND
CONTRACEPTION
 24-Hour Urine Test Sample
Collection
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Annual Gyn Screening Exam
(Practitioner use)
Assessment of Cervical Cap Fit
(Practitioner use)
Bacterial Vaginosis
Basal Body Temperature
Birth Control Pill: Side Effects
and Contraindications
Cervical Cap Consent
Cervical Cap Instructions: How
to Use Your Cervical Cap
Cervical Escharotic Treatment
(Practitioner use)
Clean Catch Urine Specimen
Condoms
Dietary Guidelines for Interstitial
Cystitis
Fertility Awareness Chart
Fertility Awareness Guidelines
Herpes Simplex I & II
How to Douche
Human Papilloma Virus (HPV)
Instructions for an Occult Blood
Test
Kegel Exercises
Kidney Stones
Menopause: Information and
Naturopathic Management
Natural Birth Control Resources
Overview of Contraceptive
Techniques
Pap Smear
Premenstrual Syndrome
Self-Breast Exam
STD Screening Lab Tests
Treatments for Cervical
Dysplasia
Urinary Tract Infections
Prevention and Treatment
Vaginal Depletion Pack
(Practitioner and Patient use)
Vaginal Infections
Well-Woman Health
Maintenance Schedule
Yoga Poses for Women’s Health
HEALTHY DIET INFORMATION
 Ayurvedic Recipes
 Basic Protein Shake Recipe
 Essential Fatty Acids
 Fatty Acid Composition of Foods
 Fiber
 Foods High in Plant Sterols
 Guidelines for Healthy Nutrition
 Health Journal Assessment
 Healthy Dining
 Healthy Fats and Oils
 Healthy Protein Sources
 Juicing for Health
 Sprouts
 Stevia
 Vegetables
 Vegetarian/Vegan-Friendly
Restaurants
 Whole Grains
HIV/AIDS TESTING AND
EDUCATION
 Food and Water Safety
 HIV Testing Consent Form
 HIV Pre-Test Counseling
 Safer Sex Practices
 Seronegative HIV Antibody Test
Results
 Seropositive HIV Antibody Test
Results
MEN’S HEALTH, UROLOGY AND
CONTRACEPTION
 24-Hour Urine Test Sample
Collection
 Clean Catch Urine Specimen
 Condoms
 Instructions for an Occult Blood
Test
 Kegel Exercises for Men
 Kidney Stones
 Natural Birth Control Resources
236
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Overview of Contraceptive
Techniques
Reproductive Self-Care for Men
STD Screening Lab Tests
Well-Man Health Maintenance
Schedule
Vaccinations
Vegetarian Diets for Children
PHYSICAL MEDICINE-EXERCISE
 Aerobic Exercise
(Cardiovascular)
 Anaerobic Exercise (Strength
Training)
 Breathing Exercises
 Everyday Stretches
 Yoga (Yogic) Breathing
ONCOLOGY
 Breast Cancer Prevention and
General Naturopathic Treatment
Guidelines
 Cancer Prevention Program
 Statement for Patients Receiving
Supportive Cancer Therapies
PHYSICAL MEDICINEHYDROTHERAPY
 Alternating Sitz Bath
 Colonic Hydrotherapy
 Compress and Immersion
Contrast Hydrotherapy
 Hot Fomentation Treatment
 Hydrotherapy for Headaches
 Hyperthermic Bath (With or
Without Peat Bath Material)
 Hyperthermic Medicinal Peat
Bath
 Ice Therapy
 Naturopathic Constitutional
Hydrotherapy
 Partial Immersion Medicinal Peat
Bath
 Therapeutic Contrast Shower
 Wet Sheet Pack
PEDIATRICS
 2 Week Well Child Check
 2 Month Well Child Check
 4 Month Well Child Check
 6 Month Well Child Check
 9 Month Well Child Check
 12 Month Well Child Check
 15 Month Well Child Check
 18 Month Well Child Check
 24 Month Well Child Check
 Chicken Pox (Varicella)
 Common Childhood Rashes
 Diaper Rash
 Fevers in Children
 Introduction to Solid Foods
 Nutrition for Ear Infections
 Physical Growth Percentiles—
Boys Birth to 36 Months (for
practitioner’s and patient’s use)
 Physical Growth Percentiles—
Boys 2 to 18 Years (for
practitioner’s and patient’s use)
 Physical Growth Percentiles—
Girls Birth to 36 Months (for
practitioner’s and patient’s use)
 Physical Growth Percentiles—
Girls 2 to 18 Years (for
practitioner’s and patient’s use)
 Therapeutic Steam Inhalation for
Children
PHYSICAL MEDICINE MISCELLANEOUS
 Carrot Poultice
 Castor Oil Pack
 Healthy Sleep Habits
 Mustard Pack
 Skin Brushing
 Steam (Essential Oil) Inhalation
 The Craniosacral Treatment
 Using the Neti Pot
 Visceral Manipulation for Hiatal
Hernia
237
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Warming Treatment for Colds
and Flu
Wet Sock Treatment
SPECIAL DIETS AND RELATED
CONDITION-SPECIFIC
THERAPEUTICS
 Anti-Estrogen and Fibroid Diet
 Cholesterol: The Good, The Bad
and The Ugly
 Constipation Dietary Guidelines
 Depression Dietary Guidelines
 Diabetes Management Diet
 Diarrhea Management Diet
 Gallbladder Disease Diet
 Gluten (Gliadin) Intolerance Diet
 Glycemic Index for Selected
Foods
 Gout Prevention Diet
 Herpes Simplex Diet
 Hypoglycemia Management Diet
 Immune Support Breakfast
 Immune Support Diet
 Irritable Bowel Syndrome Diet
 Liver Support Diet
 Low Fat (15%) Dietary
Recommendations for Heart
Disease
 Macrobiotic Diet
 Mediterranean (Omega)-Type
(35-45% Fat) Dietary
Recommendations for Heart
Disease
 Migraine Headache Diet
 Minimizing Sore Throats, Colds,
Flus and Upper Respiratory
Infections
 Osteoarthritis
 Osteoporosis Prevention and
Management Diet
 Pre- and Post-Surgery Protocol
 Recipes Featured in Low Fat
(15%) Dietary Recommendations
for Heart Disease
 Sensory Health:
Sight/Hearing/Smell/Taste/Touch
 The Genesis and Evolution of
Heart Disease
PRACTITIONER/CLINICIAN
INFORMATION AND FORMS
 Abbreviations and Acronyms
 Allergy Symptom Survey
 Annual Gyn Screening Exam
 Assessment of Cervical Cap Fit
 Bach Remedy Personalities
 Candida Questionnaire
 Cervical Escharotic Treatment
 Counselor’s Notes for Stop
Smoking Protocol
 Growth Percentiles Boys: Birth
to 36 Months
 Growth Percentiles Boys: 2 to 18
Years
 Growth Percentiles Girls: Birth
to 36 Months
 Growth Percentiles Girls: 2 to 18
Years
 Heading for Patient Handouts
Instructions
 Index of Patient Educational
Handouts Collection
 Template and Format for Patient
Handouts
 The Vocabulary of Prescriptions
 Vaginal Depletion Pack
PREGNANCY AND
BREASTFEEDING
 Breastfeeding Benefits
 Breastfeeding: Common
Questions and Problems
 Breastfeeding Support Services
 Herbs Contraindicated in
Pregnancy
 Herbs That Can Be Used in
Pregnancy
 Nausea and Vomiting of
Pregnancy
 Nutrition in Pregnancy
238
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
Individual handouts created by ND
Faculty, Residents and students
Created, compiled and edited by Pamela
Hannaman-Pittman ND MS 2002.
Bastyr Center for Natural Health.
Seattle, WA.
Editing supervisor: Lise Alschuler ND
Weight Loss and Management
Dietary Tips
SYSTEMS OF MEDICINE
 Acupuncture and Oriental
Medicine
 Ayurvedic Medicine
 The Principles of Naturopathic
Medicine
 What is Homeopathy?
Revised 12/28/02
VITAMINS AND MINERALS
 Antioxidants
 Bioflavanoids and Flavanoids
 Blood Sugar Balancing
 Calcium Content of Foods
 Coenzyme Q10
 Folate Sources
 Food Sources of Iron
 Food Sources of Nutrients
 Food Sources of Zinc
 Hydrochloric Acid
Supplementation
 Lactobacillus
Acidophilus/Bifidus
 Magnesium
 Pantothenic Acid/Vitamin B5
 Safety of Vitamins and Minerals
 Self-Administration of Vitamin
B12
 The Importance of Dietary
Copper
 Vegetarian Sources of Nutrients
 Vitamin E
 Vitamin A and Beta-Carotene
 Vitamin B6
 Vitamin B12
 Vitamin C and Bowel Tolerance
 Why Consider Vitamin and
Mineral Supplementation
Resources
References and resources listed on each
individual handout
239
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Appendix 6b
Index of Nutrition Patient Handouts
General Handouts
CAFFEINE
 Caffeine: Its action in the body
and common sources
 Decaffeinating yourself
FIBER
 Dietary fiber
 Fiber content of foods
GENERAL EATING
 Eating to nourish
 General eating guidelines
 Healthy Exchange
 Eat a variety of foods
 Food guide pyramid
COOKBOOK
 Allergy
 Bean
 Cookbooks for health
 Healthy cookbooks with
annotated bibliographies
 Soy
 Vegetarian
 Whole grains
GRAINS
 Cooking with grains
 Guide to cooking with grains
 Whole grains shopping list
DETOXIFICATION
 Detox: Chronic mercury toxicity
 Detox: Health maintenance diet
 Detoxification diet
LEGUMES
 Beans and grains cooking guide
(PCC handout)
 Improving the digestibility of
legumes
 Legumes
 Reducing flatulence caused by
eating beans
 Soups (lentil & black bean soup
recipes)
DIETS/FOOD PLANS
 Food combining
 The anti-estrogen diet
EATING OUT
 Dining out
 Fast foods
MEAL PLAN SAMPLES
 1200 calories
 1500 calories
 1800 calories
 2000 calories
EXERCISE
 How to exercise
 Meditation resources
FATS
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Lipids
Lowdown on fats
Understanding of dietary fats
Omega-3 and -6 sources
Dietary sources of fat
Essential fatty acids
Fats
Fatty acid composition of foods
Flax oil recipes
Good fats
Lipids, fats and oils
MINERALS – CALCIUM &
MAGNESIUM
 Calcium content of foods
 Calcium in a vegetarian diet
 Calcium making bones!
 Magnesium
 Non-dairy sources of calcium
240
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MINERALS – SODIUM &
POTASSIUM
 No salt
 Sodium
VEGETARIAN
 Food sources of essential
nutrients
 Vegetarian – 100g of protein per
day
 Vegetarian diet – children
 Vegetarian-friendly restaurants
 Vegetarian protein sources
 Vegetarian recipes
 Vegetarian iron sources
 Vegetarian athletes
 Vegetarian pyramid
MINERALS – ZINC & IRON
 Iron food sources
 Zinc
 Zinc food sources
 Zinc in a vegetarian diet
PEDIATRIC
 Introduction of solid foods
 Vegetarian nutrition for schoolaged children
 Vegetarian nutrition for toddlers
and preschoolers
VITAMINS – FAT SOLUBLE
 Vitamin E
 Vitamin A in foods
 Vitamin K
PREGNANCY
 Breastfeeding diet
 Guide to a healthy pregnancy
 Pregnancy – eating for two
VITAMINS – GENERAL
 Antioxidants
 Vitamins – information and
sources
 Antioxidants – Dairy Council
PROTEIN
 Include protein in your early
morning meal
 Protein
 Complementary protein
 Protein sources
VITAMINS – WATER SOLUBLE
 Vitamin B6
 Folacin in foods
 Folate (Dairy Council)
 Vitamin B12
 Vitamin C in foods
 Vitamin B12 in a vegan diet
SOY
 Miso soup
 Soy foods
WEIGHT GAIN PROMOTION
 Smoothie recipes
 Weight gain
 Weight gain ideas
SWEETENERS
 Sugar and alternative sweeteners
 Guide to using natural
sweeteners
 Sweeteners
 Sweeteners to restrict
WEIGHT LOSS
 Coaching yourself to slenderness
 Fiber and weight loss
 Obesity
 Psychology of weight loss
 Strategies for weight loss
 Weight loss
VEGETABLES
 Sea vegetables
 Vegetables
241
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Weight loss – eating for health
WHOLE FOODS
 Eating to nourish
 Natural food stores and delis
 Whole foods guide
1800 calorie wheat free meal
plan
ALLERGIES – GLUTEN
 5 day gluten free and dairy free
meal plan
 Gluten free recipes
 Gluten/Gliaden free diet
Disease States
ALLERGIES – MISC.
 Pediatric allergy prevention
recommendations
 Amine foods
 Common childhood food
allergies
 Detoxification diet
 Dietary pulse survey
 Discount allergy supplies
 Environmental health resource
list
 Fasting: a 3 day meal plan
 Food additives to avoid
 Food combining
 Hypoallergenic diet
BONE HEALTH
 Osteoporosis
ALLERGIES – ELIMINATION
DIETS
 Gaby elimination diet
 Elimination diet
 Elimination diet recipes
 How to challenge
 1800 calorie elimination diet
meal plan
ALLERGIES – DAIRY
 Alternatives to dairy
 Cheese alternatives
 Milk allergies
 What to do if your child is
allergic to milk
ALLERGIES – FOOD GROUPS
 Corn allergy
 Egg allergy
 Egg containing foods
 Foods containing corn, corn
syrup and corn sugar
 Peanut allergy
 No more peanuts
CANCER
 Breast cancer
 Chemotherapy
 Nutrition, cancer and the immune
system
CANDIDA
 Candida diet
 Candida questionnaire
 Foods containing yeast
 Canker sores
 Candida albicans
ALLERGIES – WHEAT
 Enjoying a wheat free diet
 Foods containing wheat
 Wheat, dairy free foods at QFC
 Wheat and gluten free recipes
 Wheat flour
 Wheat free diet
 Wheat free products/recipes
 1500 calorie wheat free meal
plan
CARDIOVASCULAR
 Book list for healthy heart
 Cholesterol
 Dietary fat and cholesterol
242
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How to avoid fat, saturated fat,
cholesterol
Hypercholesterolemia
Magnesium and cardiovascular
health
Practical tips for modifying
dietary fat intake
Prostiglandins
Reversing heart disease
You can lower your cholesterol
Foods and migraines
HERPES
 Herpes diet
 Lysine/arginine content of foods
HYPERTENSION
 Are you at risk for high blood
pressure?
 DASH diet (needs to be
developed)
 High blood pressure
 No salt
 Sodium
 What is hypertension?
DEPRESSION
 Nutrition intervention for
depression
 Amino acids: their role in mood
& brain disorders
HYPOGLYCEMIA
 3 components of food
 How to maintain blood sugar
 Managing hypoglycemia]
 Mixed food sources
 Smart snacks/small meals for
blood sugar control
 Suggestions to help maintain
acceptable blood sugar
DIABETES
 Blood sugar control: snacks &
meals
 Carbohydrate distribution
 Carbohydrates: what are they?
 Diabetes food guide pyramid
 Diabetes Mellitus
 Glycemic index of selected foods
 Maintaining acceptable blood
sugar levels
 Mixed food sources for blood
sugar control
 Type 2 diabetes
IMMUNE SYSTEM/HIV
 Common cold
 Facts on food safety
 Enhancing your vitality
 HIV/AIDS – treatment for
diarrhea
 Immune support breakfast
 Immune support menu ideas
 Immune support with nutrition –
HIV/AIDS guidelines
 Liver protocol
 Liver support
GASTROINTESTINAL
 Acidophilus
 Constipation
 Diet modification for fat
malabsorption
 Fat malabsorption
 Irritable bowel syndrome
 Nutrition suggestions for
controlling diarrhea
 Pre/Probiotics
 Treatment considerations for IBS
 Ulcerative colitis
MISCELLANEOUS
 Diet guidelines for interstitial
cystitis
 Foods and beverages that trigger
rosacea flare-ups
 Hiatal hernia
HEADACHES
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Chronic fatigue syndrome
Chronic mercury toxicity
Gall bladder disease diet
guidelines
Otitis media
Restless leg syndrome
RENAL/KIDNEY
 Kidney stones
 Low oxalates
 Renal problems
 Resources for low salt, low
potassium diets
PMS, MENOPAUSE &
AMMENORRHEA
 Foods low in plant sterols
 Foods high in plant sterols
 Anti-estrogen diet
PULMONARY
 COPD
 Emphysema
SMOKING
 Quit smoking protocol week 1
 Ways to help you stop smoking
 Stop smoking protocol for
counseling
244
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Appendix 7
ND Physical Exam Guidelines for
Clinical Competencies
Well Child Exam
Denver Developmental Screening
Test
Measurements
Height - chart on graph
Weight - chart on graph
Head circumference - to 12 mos. chart on graph
Well Child Exam, continued
Blood Pressure - begin at 3 years
Pulse
Respiratory rate
Temperature
Observe skin
Female Reproductive Exam
Breast Exam
Observe - pigmentation, retraction,
asymmetry, nipple discharge
Palpate - masses, nipple discharge,
pain
Nodes - axillary, clavicular
Pelvic Exam
Observe - ext. genitalia - hair, skin,
labia, perineum
Palpate - nodes, inguinal
BSU glands
Cystocele/Rectocele
Speculum exam - inspect vagina,
cervix, samples
Bimanual exam - uterus, adnexae
Rectal/vaginal
Anus/rectum - inspect, palpate, stool
guiac
HEENT Exam
Observe
Inspect
Palpate
Chest Exam
Observe
Inspect
Palpate
Thorax/back and front
Breast
Lung - auscultate
Heart - auscultate
Male Reproductive Exam
Penis/Scrotum Exam
Observe - lesion, discharge,
asymmetry
Palpate - masses, discharge, pain
Nodes - inguinal
Abdominal Exam
Observe
Auscultate
Percuss
Palpate
Liver
Stomach
Spleen
Kidneys
Intestines
Aorta
Inguinal nodes
Hernia Inspection and Palpation
Prostate Exam
Palpate - enlargement, masses, pain
asymmetry
Anus/Rectal Exam
Observe - hemorrhoids, other lesions
Palpate - masses
Stool guiac
245
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Genitalia and Rectal Exam
Observe
Inspect
Palpate - scrotum, penis, anus
Musculoskeletal Exam
Observe - posture, form, gain,
movements, tone
Palpate - back, extremities, joints
246
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28. Palpate neck for nodes
29. Palpate thyroid
30. Inspect and percuss spine and
renal angles
31. Examine chest: symmetry and
expansion
32. Percuss posterior and lateral
chest
33. Auscultate posterior and lateral
chest
34. Percuss anterior lung fields
35. Auscultate anterior lung fields
36. Palpate breasts
37. Palpate axillary nodes
38. Inspect neck veins
39. Test hepatojugular reflux
40. Palpate carotids
41. Inspect precordium
42. Palpate precordium
43. Percuss cardiac border
44. Auscultate heart
45. Auscultate carotids
46. Auscultate midepigastrium
47. Auscultate femoral areas
48. Inspect abdomen
49. Palpate abdomen
50. Palpate bimanually for liver
51. Palpate bimanually for spleen
52. Palpate inguinal nodes
53. Palpate femoral pulses
54. Palpate for femoral hernia
55. Inspect, palpate, flex and extend
feet legs
56. Test for pretibial edema
57. Palpate dorsalis pedis and
posterior tibial pulses
58. Test plantar reflexes
59. Test knee and ankle reflexes
60. Test biceps and triceps reflexes
61. Test rapid alternating movements
62. Test finger to nose
63. Test heel to shin
64. Test light touch and pinprick on
limbs
65. Test position sense in feet
66. Test vibration sense in feet
Neurological Exam
Infantile reflexes
Test for:
Cranial nerves
Motor function
Sensory function
DTR’s
Cognitive function
72 Step Screening Physical Exam
1. Wash hands
2. Inspect general appearance
3. Take oral temperature
4. Palpate, count and compare
radial pulses
5. Count respiratory rate
6. Measure blood pressure
7. Inspect hands, nails, skin, joints,
palms
8. Inspect, palpate, flex and extend
forearms and arms
9. Inspect face and head
10. Test visual acuity
11. Check visual fields
12. Test ocular movements
13. Inspect conjunctiva, sclera,
cornea
14. Test pupillary reactions to light
and accommodation
15. Ophthalmoscopy
16. Examine external ears
17. Otoscopy
18. Examine nose
19. Wrinkle forehead
20. Palpate masseters with teeth
clenched
21. Show teeth
22. Protrude tongue
23. Inspect lips, gums, teeth, tongue,
buccal mucosa
24. Inspect pharynx and have patient
phonate
25. Test range of motion of neck
26. Shrug shoulders
27. Extend arms over head
247
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67. Hold arms extended
68. Romberg test
69. Check gait
70. Walk on toes
71. Pelvic examination
72. Rectal examination
248
Student Clinician Handbook, 2003-2004
Inspect
Palpate
Symmetry, enlargement
Nodes - auricular, tonsillar,
submaxillary, submental,
cervical, supraclavicular,
suboccipital
Trachea - symmetry
Thyroid - masses, enlargement
Carotids/Jugulars - pulsations
HEENT Exam
Head
Examine
Inspect
Hair
Scalp
Skull
Face
Skin
Eyes
Acuity
Visual fields
Observe - position, alignment,
eyelids, lacrimal ducts,
conjunctiva, sclera
Examine - cornea, lens, pupil
EOM
Ophthalmoscopic exam - lens,
retina, disc, cup, vessels
Ears
Inspect auricle - lesions
Otoscopic exam - external canal,
TM
Acuity - gross, Weber, Rinne
Nose
Inspect external and internal nose
- lesions, mucosa condition
Sinus palpation
Mouth/Pharynx
Examine
Inspect
Lips
Buccal mucosa
Gums
Teeth
Roof
Tongue
PharynxU.
Clinical Training Clinical Competencies
Neck
Examine
249
Student Clinician Handbook, 2003-2004
Pulses - radial, pedal
Blood Pressure
JVP
Abdominojugular Test
Inspect - apical impulse, edema
Palpate - size, location, apical
impule
Auscultate - rate, rhythm, extra
sounds, bruits (in all three
positions: recumbant 30 degrees,
left lateral decubitus, leaning
foreard)
ND CLINICAL COMPETENCIES:
PHYSICAL EXAM OUTLINE
Abdominal Exam
Observe - skin, umbilicus,
contour, peristalsis,
pulsations
Auscultate - bowel sounds, bruits
Percuss
Palpate - light, deep
Liver
Stomach
Spleen
Kidneys
Intestines
Special techniques - as
appropriate
Murphy’s
McBurney’s
Musculoskeletal Exam
Inspect
Palpate
Strength and ROM - passive,
active, resisted
TMJ
Cervical spine
Hands, wrists, fingers
Elbows
Shoulder
Hips
Knees
Ankles
Feet, toes
Spine
Respiratory Exam
Observe - color, fingernails,
respiratory distress
Respiratory rate
Posterior Chest
Inspect - asymmetry
Palpate - masses, pain
Fremitus - dullness, resonance
Respiratory expansion
Percuss - dullness, resonance
Auscultate - breath sounds,
adventitious sounds,
transmitted voice
Neurological Exam
Mental Status and Speech
Exam
Cranial Nerve Exam
Smell (1)
Visual acuity, fields (2)
Pupillary rxns (2,3)
EOM (3,4,6)
Corneal reflex, jaw movement
(5)
Facial movement (7)
Hearing (8)
Swallowing, rise of palate (9.10)
Voice (10)
Speech (5,7,10.12)
Shoulder shrug (11)
Tongue movement (12)
Anterior Chest
Inspect - asymmetry
Palpate - masses, pain
Fremitus - dullness, resonance
Respiratory expansion
Percuss - dullness, resonance
Ausculate - breath sounds,
adventitious sounds,
transmitted voice
Cardiovascular Exam
250
Student Clinician Handbook, 2003-2004
Motor Nerve Exam
Observe gait, heel-toe, hop, bend
Romberg
Extend, elevate arms - hold
Grip strength
Observe for bulk, tone,
involuntary movements
Test for Muscle Strength
Compare, flex, extend joints
against resistance
fingers
wrists
elbows
shoulders
neck
hips
knees
ankles
feet
toes
Rapid Alternating Motion - upper
and lower extremities
Point-to-Point Testing - upper
and lower extremities
Deep Tendon Reflex Exam
Grade, compare
Biceps
Triceps
Brachioradialis
Abdominal
Quadriceps
Achilles
Plantar
Sensory Exam
Test/compare pain in hands and feet
Test/compare vibration sense in
hands and feet
Test/compare light touch in arms and
legs
Test/compare stereognosis in hands
251
Student Clinician Handbook, 2003-2004
Abbreviation
BMR
BNO
BP
BPH
BUN
bx
C1, C2 to C8
Appendix 8
Medical Abbreviations
The use of medical and scientific
abbreviations is time saving and often a
standard practice in the healthcare
industry. A number of the abbreviations
may appear with or without periods and
with either capital or small letters.
Abbreviation
AAMA
Assistants
AB, ab
ABC
ABG
ac
AC
Acc
ACG
ACS
ACTH
AD
ad lib
adeno-CA
ADH
AE
AFB
AFP
AIDS
AK
AKA
ALL
AMA
AMI
ANS
AP
AandP
ARDS
ARMD
AS
ASD
ASHD
Astigm
ATN
AV
AVR
BaE
baso
BBB
BE
bid
BIN, bin
BK
BKA
BM
CA, Ca
CAD
CAT, CT
CBC
cc
Meaning
American Association of Medical
cc
CCU
CDC
CDH
CEA
CHD
CHF
CI
cm
CMA
CMML
CNS
CO2
COLD
COPD
abortion
aspiration biopsy cytology
arterial blood gas
before meals (ante cibum)
air conduction
accommodation
angiocardiography
American Cancer Society
adrenocorticotropic hormone
right ear (auris dextra)
as desired
adenocarcinoma
antidiuretic hormone
above the elbow
acid-fast bacillus
alpha-fetoprotein
acquired immunodeficiency
syndrome
above the knee
above-knee amputation
acute lymphocytic leukemia
American Medical Association
acute myocardial infarction
autonomic nervous system
anteroposterior
auscultation and percussion
adult respiratory distress
syndrome
age-related macular degeneration
aortic stenosis; left ear (auris
sinistra)
atrial septal defect
arteriosclerotic heart disease
astigmatism
acute tubular necrosis
atrioventricular, arteriovenous
aortic valve replacement
barium enema
basophil
bundle-branch block
below the elbow
twice a day
twice a night
below the knee
below-knee amputation
bowel movement
CP
CPD
CPR
CS, C-section
CSF
CT
CTS
CV
CVA
CVD
CWP
CXR
cysto
D
do
/d
DandC
DDS
DandE
Derm
DI
diff
DM
DO
DOA
DOB
DPT
DRGs
252
Meaning
basal metabolic rate
bladder neck obstruction
blood pressure
benign prostatic hyperplasia
blood urea nitrogen
biopsy
first cervical vertebra, second
cervical vertebra through eighth
cervical vertebra
cancer, calcium
coronary artery disease
computerized axial tomography
complete blood count
cardiac catheterization; chief
complaint
cubic centimeter
coronary care unit
Centers for Disease Control
congenital dislocation of the hip
carcinoembryonic antigen
coronary heart disease
congestive heart failure
chlorine
centimeter
certified medical assistant
chronic myelomonocytic leukemia
central nervous system
carbon dioxide
chronic obstructive lung disease
chronic obstructive pulmonary
disease
cerebral palsey
cephalopelvic disproportion
cardiopulmonary resuscitation
cesarean section
cerebrospinal fluid
computed tomography
carpal tunnel syndrome
cardiovascular
cerebrovascular accident
cardiovascular disease
childbirth without pain
chest x-ray
cystoscopy
diopter (lens strength)
discontinue
per day
dilation and curettage
Doctor of Dental Surgery
dilation and evacuation
dermatology
diabetes insipidus; diagnostic
imaging
differential count (white blood
cells)
diabetes mellitus
doctor of osteopathy
dead on arrival
date of birth
diphtheria, pertussis, tetanus
diagnostic related groups
Student Clinician Handbook, 2003-2004
Abbreviation
DUB
DVT
dx
EBV
ECG, EKG
ECF
EDC
EEG
EENT
EMG
ENT
EOM
eosin
ESR
EST
ET
F
FACP
FAGS
FBS
FDA
FEF
FEKG
FEV
FH
FHR
FHT
FS
FSH
FTND
FUO
FVC
Fx
GB
GC
GH
GI
gm
gr
GTT
Gtt
GU
Gyn
H
h
HCG
HCI
HCO
HCT, hot
HD
HDL
HEENT
Hg
Hgb, Hb
HIV
HMD
HNP
Meaning
dysfunctional uterine bleeding
deep vein thrombosis
diagnosis
Epstein-Barr virus
electrocardiogram
extracellular fluid; extended care
facility
estimated or expected date of
confinement
electroencephalogram
eye, ear, nose, and throat
electromyogram
ear, nose, and throat
extraocular movement
eosinophil
erythrocyte sedimentation rate
electric shock therapy
esotropia
Fahrenheit
Fellow, American College of
Physicians
Fellow, American College of
Surgeons
fasting blood sugar
Food and Drug Administration
forced expiratory flow
fetal electrocardiogram
forced expiratory volume
family history
fetal heart rate
fetal heart tone
frozen section
follicle-stimulating hormone
full-term normal delivery
fever of undetermined origin
forced vital capacity
fracture
gallbladder
gonorrhea
growth hormone
gastrointestinal
gram
grain
glucose tolerance test
drops (guttae)
genitourinary
gynecology
hypodermic; hydrogen
hour
human chronic gonadotropin
hydrochloric acid
bicarbonate
hematocrit
hip disarticulation; hemodialysis;
hearing distance; Hodgkin's
disease
high-density lipoprotein
head, eyes, ears, nose, and throat
mercury
hemoglobin
human immunodeficiency virus
HP
hs
HSG
HSV
hypo
IAS
IBD
ICF
ICSH
ICU
IandD
ID
IDDM
Ig
IH
IM
inj
IOL
iop
IPPB
IQ
IRDS
IS
IUD
IV
IVC
IVF
IVP
IVS
K
KD
kg
KS
KUB
l
L1, L2 to L5
LA
LandA
LAT, lat
LB
LDL
LE
LH
LLQ
LMP
LP
LPN
LRQ
LUQ
LV
lymphs
253
hyaline membrane disease
herniated nucleus pulposus
(herniated disk)
hemipelvectomy
at bedtime
hysterosalpingography
herpes simplex virus
hypodermically
interatrial septum
inflammatory bowel disease
intracellular fluid
interstitial cell-stimulating
hormone
intensive care unit
incision and drainage
intradermal
insulin-dependent diabetes
mellitus
immunoglobulin
infectious hepatitis
intramuscular
injection
intraocular lens
intraocular pressure
intermittent positive-pressure
breathing
intelligence quotient
infant respiratory distress
syndrome
intercostal space
intrauterine device
intravenous
inferior vena cava, intravenous
cholangiography
in vitro fertilization
intravenous pyelogram
interventricular septum
potassium
knee disarticulation
kilogram
Kaposi's sarcoma
kidney ureter bladder
liter
first lumbar vertebra, second
lumbar vertebra through fifth
lumbar vertebra
left atrium
light and accommodation
lateral
large bowel
low-density lipoprotein
lupus erythematosus, lower
extremity
luteinizing hormone
left lower quadrant
last menstrual period
lumbar puncture
Licensed Practical Nurse
lower right quadrant
left upper quadrant
left ventricle
lymphocytes
Student Clinician Handbook, 2003-2004
Abbreviation
MCH
MCHC
MCV
MD
mets
mg
MH
MI
mix. astig
ml
mm
mono
MRI
MS
MSH
MVP
Myop
Na
NPH
NPO
NSAID
O2
OA
OB
OB-GYN
OCPs
OD
od
OHS
OR
Ortho, ORTH
OS
os
Oto
OU
OV
oz
P
PA
Pap smear
paren
PAT
Path
PBI
PC
PCP
PCV
PD
PE
PET
PGH
pH
PID
PKU
PMN
PMP
Meaning
mean corpuscular hemoglobin
mean corpuscular hemoglobin
concentration
mean corpuscular volume
Medical Doctor
metastases
milligram (1/1000 gram)
marital history
myocardial infarction; mitral
insufficiency
mixed astigmatism
milliliter (1/1000 liter)
millimeter (1/1000 meter; 0.039
inch)
monocyte
magnetic resonance imaging
mitral stenosis; multiple sclerosis
melanocyte-stimulating hormone
mitral valve prolapse
myopia
sodium
neutral prolamine Hagedorn
(insulin)
nothing by mouth (nulla per os)
nonsteroidal anti-inflammatory
drug
oxygen
osteoarthritis
obstetrics
obstetrics and gynecology
oral contraceptive pills
right eye (oculus dexter); overdose
once a day
open heart surgery
operating room
orthopedics
left eye (oculus sinister)
mouth; opening; bone
otology
both eyes (oculi unitas)
office visit
ounce
pulse
posteroanterior
Papanicolaou's smear
parenterally
paroxysmal atrial tachycardia
pathology
protein-bound iodine
after meals
Pneumocystis carinii pneumonia
packed cell volume (hematocrit)
peritoneal dialysis
physical examination
positron emission tomography
pituitary growth hormone
hydrogen ion concentration
pelvic inflammatory disease
phenylketonuria
polymorphonuclear neutrophil
previous menstrual period
Abbreviation
PND
PNS
PO
poly
pp
prn
PT
PTH
PTT
PVC
q
qam
qd
qh
q2h
qid
qpm
qns
R, rt
RA
rad
RAI
RBC
RD
REM
RLQ
R.N.
RNA
R/O
ROM
RP
RU
RUQ
RV
Rx
s
S1, S2 to S5
SA
SC
SCD
SD
seg
SGOT
SGPT
SH
SLE
SOB
SOS
sp. gr.
SR
St
staph
stat
STD
strep
subcu,subq
254
Meaning
paroxysmal nocturnal dyspnea
peripheral nervous system
orally
polymorphonuclear neutrophil
postprandial (after meals)
as required
prothrombin time; Physical
Therapy
parathyroid hormone
partial thromboplastin time
premature ventricular contraction
every
every morning
every day (quaque die)
every hour
every two hours
four times a day
every night
quantity not sufficient
right
right atrium, rheumatoid arthritis
radiation absorbed dose
radioactive iodine
red blood cell; red blood count
respiratory disease
rapid eye movement
right lower quadrant
registered nurse
ribonucleic acid
rule out
range of motion
retrograde pyelogram
routine urinalysis
right upper quadrant
right ventricle
prescription, treatment, therapy
without
first sacral vertebra, second sacral
vertebra through fifth sacral
vertebra
sinoatrial node
subcutaneous
sudden cardiac death
shoulder disarticulation
polymorphonuclear neutrophil
serum glutamic-oxaloacetic
transaminase
serum glutamic-pyruvic
transaminase
serum hepatitis
systemic lupus erythematosus
shortness of breath
if necessary
specific gravity
sedimentation rate
strabismus (esotropia)
staphylococcus
immediately
sexually transmitted disease
streptococcus
subcutaneous
Student Clinician Handbook, 2003-2004
Abbreviation
Svc
SVD
T
T1, T2 to T12
T3
T4
TAH
TandA
TB
THA
THR
TIA
tid
TKA
TKR
TNM
top
TPN
TPR
TPUR
TSH
TSS
TUR, TURP
TX
U
UA
UC
UGI
ULQ
ung
URI
UTI
UV
VA
VC
VD
VF
VHD
VLDL
VSD
WBC
wt
w/v
x
XP
XT
XX
XY
Meaning
superior vena cava
spontaneous vaginal delivery
temperature
first thoracic vertebra, second
thoracic vertebra through twelfth
thoracic vertebra
triiodothyronine
thyroxine
total abdominal hysterectomy
tonsillectomy and adenoidectomy
tuberculosis
total hip arthroplasty
total hip replacement
transient ischemic attack
three times a day
total knee arthroplasty
total knee replacement
tumor, nodes, metastasis
topically
total parenteral nutrition
temperature, pulse, and respiration
transperineal urethral resection
thyroid-stimulating hormone
toxic shock syndrome
transurethral resection of the
prostate
tumor cannot be assessed
units
urinalysis
uterine contractions
upper gastrointestinal
upper left quadrant
ointment
upper right quadrant
urinary tract infection
ultraviolet
visual acuity
vital capacity
venereal disease
visual field
ventricular heart disease
very-low-density lipoprotein
ventricular septal defect
white blood cell (count); white
blood count
weight
weight by volume
multiplied by
xeroderma pigmentosa
exotropia
female sex chromosomes
male sex chromosomes
255
Student Clinician Handbook, 2003-2004
Appendix 9
A. Documentation Guidelines for
Evaluation and Management Services
This is an update of the guidelines
jointly produced by the American
Medical Association (AMA) and CMS
in May, 1997. It incorporates revisions
to the gastrointestinal section of the
general multi-system exam and the skin
section of the single organ system exam
of the skin. These revisions were
approved by the AMA and CMS in
November, 1997.
American Medical Association
Health Care Financing
Administration
NOVEMBER, 1997
256
Student Clinician Handbook, 2003-2004
B.
by the examining physician and are
based upon clinical judgment, the
patient's history, and the nature of the
presenting problem(s).
Documentation of Examination
The levels of E/M services are based on
four types of examination:
• Problem Focused -- a limited
examination of the affected body area or
organ system.
• Expanded Problem Focused -- a
limited examination of the affected body
area or organ system and any other
symptomatic or related body area(s) or
organ system(s).
• Detailed -- an extended examination of
the affected body area(s) or organ
system(s) and any other symptomatic or
related body area(s) or organ system(s).
• Comprehensive -- a general
multi-system examination, or complete
examination of a single organ system
and other symptomatic or related body
area(s) or organ system(s).
The content and documentation
requirements for each type and level of
examination are summarized below and
described in detail in tables beginning on
page 261. In the tables, organ systems
and body areas recognized by CPT for
purposes of describing examinations are
shown in the left column. The content,
or individual elements, of the
examination pertaining to that body area
or organ system are identified by bullets
(•) in the right column.
Parenthetical examples, "(eg, ...)", have
been used for clarification and to provide
guidance regarding documentation.
Documentation for each element must
satisfy any numeric requirements (such
as "Measurement of any three of the
following seven...") included in the
description of the element. Elements
with multiple components but with no
specific numeric requirement (such as
"Examination of liver and spleen")
require documentation of at least one
component. It is possible for a given
examination to be expanded beyond
what is defined here. When that occurs,
findings related to the additional systems
and/or areas should be documented.
These types of examinations have been
defined for general multi-system and the
following single organ systems:
•
•
•
•
•
•
•
•
•
•
•
Cardiovascular
Ears, Nose, Mouth and Throat
Eyes
Genitourinary (Female)
Genitourinary (Male)
Hematologic / Lymphatic /
Immunologic
Musculoskeletal
Neurological
Psychiatric
Respiratory
Skin
• DG: Specific abnormal and relevant
negative findings of the examination of
the affected or symptomatic body area
(s) or organ system (s) should be
documented. A notation of "abnormal"
without elaboration is insufficient.
A general multi-system examination or a
single organ system examination may be
performed by any physician regardless
of specialty. The type (general
multi-system or single organ system)
and content of examination are selected
• DG: Abnormal or unexpected findings
of the examination of any asymptomatic
257
Student Clinician Handbook, 2003-2004
body area(s) or organ system(s) should
be described.
body areas. For each system/area
selected, all elements of the examination
identified by a bullet (•) should be
performed, unless specific directions
limit the content of the examination. For
each area/system, documentation of at
least two elements identified by a bullet
is expected.
• DG: A brief statement or notation
indicating "negative" or "normal” is
sufficient to document normal findings
related to unaffected area(s) or
asymptomatic organ system(s).
GENERAL MULTI SYSTEM
EXAMINATIONS
General--multi-system examinations are
described in detail beginning on page
261. To qualify for a given level of
multi-system examination, the following
content and documentation requirements
should be met:
SINGLE ORGAN SYSTEM
EXAMINATION
The single organ system examinations
recognized by CPT are described in
detail beginning on page 18. Variations
among these examinations in the organ
systems and body areas identified in the
left columns and in the elements of the
examinations described in the right
columns reflect differing emphases
among specialties. To qualify for a given
level of single organ system
examination, the following content and
documentation requirements should be
met:
• Problem Focused Examination—
should include performance and
documentation of one to five elements
identified by a bullet (•) in one or more
organ system(s) or body area(s).
• Expanded Problem Focused
Examination—should include
performance and documentation of at
least six elements identified by a bullet
(•) in one or more organ system(s) or
body area(s).
• Problem Focused Examination—
should include performance and
documentation of one to five elements
identified by a bullet (•), whether in a
box with a shaded or unshaded border.
• Detailed Examination—should
include at least six organ systems or
body areas.
•.Expanded Problem Focused
Examination—should include
performance and documentation of at
least six elements identified by a bullet
(•), whether in a box with a shaded or
unshaded border.
For each system/area selected,
performance and documentation of at
least two elements identified by a bullet
(•) is expected. Alternatively, a detailed
examination may include performance
and documentation of at least twelve
elements identified by a bullet (•) in two
or more organ systems or body areas.
• Detailed Examination—examinations
other than the eye and psychiatric
examinations should include
performance and documentation of at
least twelve elements identified by a
bullet (•), whether in box with a shaded
or unshaded border.
• Comprehensive Examination—should
include at least nine organ systems or
258
Student Clinician Handbook, 2003-2004
• Eye and psychiatric examinations
should include the performance and
documentation of at least nine elements
identified by a bullet (•), whether in a
box with a shaded or unshaded border.
• Comprehensive Examination—should
include performance of all elements
identified by a bullet (•), whether in a
shaded or unshaded box. Documentation
of every element in each box with a
shaded border and at least one
element in each box with an unshaded
border is expected.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
(continued on following pages)
Multi-System Screening Examination
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Check height and weight
Wash hands
Inspect general appearance
Check oral temperature
Palpate count compare radial
pulse
Count respiratory rate
Measure blood pressure
Inspect skin, nails, joints
Inspect head and face
Check visual acuity CNII
Inspect eyes
Test pupillary reaction to light
and accommodation
Test ocular muscles
Test ocular movements CN III,
IV, VI
Fundoscopic exam
Check auditory acuity CN VIII
Examine external ears
Otoscopy
Examine nose and sinuses
Inspect pharynx and have patient
phonate CN IX, X, XII
Inspect lips, tongue, teeth, buccal
mucosa
Palpate thyroid
Examine posterior chest
Check tactile fremitis
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
259
Percuss posterior and lateral
chest
Auscultate posterior and lateral
chest
Percuss anterior lung fields
Auscultate anterior lung fields
Inspect and palpate precardium
Percuss cardiac border
Auscultate heart
Auscultate carotids
Auscultate abdomen and midepigastrium
Auscultate femoral areas
Palpate carotid arteries
Palpate femoral pulses
Palpate posterior tibial and
dorsalis pedis pulses
Check for pre-tibial edema
Inspect abdomen
Palpate abdomen
Palpate bimanually for liver
Palpate bimanually for spleen
Palpate for femoral hernia
Palpate neck for nodes
Palpate axillary nodes
Palpate epitroclear nodes
Palpate inguinal nodes
Test ROM of cervical spine
Test ROM of lumbar spine
Percuss spine and renal angles
Test ROM of upper extremities
bilaterally
Test ROM of lower extremities
bilaterally
Examine joints
Test CN V sensory and motor
Tests CN VII motor
Test CN XI motor
Test biceps and triceps reflexes
Test patellar and achilles reflexes
Test for fine touch and pinprick
on extremities
Check gait
Assess judgment and insight
Assess orientation to person,
place, time
Student Clinician Handbook, 2003-2004
63.
Assess recent and remote
memory
64.
260
Assess mood
Student Clinician Handbook, 2003-2004
MULTI SYSTEM EXAMINATION
Patient Name____________________________ Doctor_________________________
Date_____________________
CONSTIT
UTIONAL
Vitals
(perform 3)
General
appearance
PSYCH
SKIN
B.P.
Temp
Pulse
Ht.
RR
Wt.
No deformities
noted
Appears neat and
well groomed
Appears well
nourished
Oriented X 3
Recent and remote memory intact
No mood disorders noted
Judgment and insight WNL
No scars, rashes, ulcers, discoloration or lesions noted.
No in duration, sub-Q nodules, tightening.
EYES
Sclera white, conjunctive clear, no lid lag
PERRLA (direct and consensual B/L)
Discs flat, no exudate, no hemorrhage, vessels intact
Extra-occular movements intact B/L
Visual fields by confrontation WNL B/L
Visual acuity intact B/L
EARS, NOSE,
THROAT
No scars, lesions, or masses on ears
Hearing intact B/L
Tympanic membranes translucent, non-bulging.
Canal walls pink no discharge
Mucosa and turbinates pink. Septum midline,
no sinus tenderness
Lips pink and symmetrical, gums pink, good dentition
Oral mucosa pink and moist. Tongue moist, no ulcers.
Pharynx pink, no exudate, lesions or inflammation.
NECK
Full ROM, trachea midline, no masses
No thyromegaly
RESPIRATORY Respiration even and un-labored
CARDIOVASC.
Lung fields: No flatness, dullness, or hyperresonance
Tactile fremitus absent
Clear/equal, no adventitious sounds B/L
No lifts, heaves, thrills. PMI present.
Percussion of cardiac borders WNL.
RRR no murmurs, rubs, gallops, S1 and S2 WNL
Carotids, femoral No bruits
Abdominal aorta No bruits
Size__________
Politely, tibias and pedals WNL B/L
Carotids, brachial, radials WNL B/L
No edema or varicosities
261
Notes:
Student Clinician Handbook, 2003-2004
No masses, tenderness or hernias noted.
Notes:
A
B
Percussion WNL Bowel sounds intact x 4 quads.
Liver and spleen w/out tenderness or enlargement.
D
CVA tenderness absent B/L
O
M
Rectal: even sphincter tone, no
Not indicated
hemorrhoids or masses.
E
N
Hemoccult negative.
Not indicated
MUSCULOSKEL Gait
Coordinated and
smooth.
No clubbing,
Digits
cyanosis, or
lesions.
WNL B/L
Grip Strength
Joints intact.
Joints/bones/muscle
___Head/neck
___Spine/rib/pelvis
Joints w/ full
___R upper extremity
ROM No pain,
___L upper extremity
crepitus, or
___R lower extremity
contracture.
___L lower extremity
No misalignment,
(minimum 1 of above)
deformity, defects
or subluxation.
No muscle
atrophy/weakness.
Cranial
Intact B/L
NEUROLOGICAL
Nerves I-XII
Sensation
WNL B/L
Torso/extremities
(touch, pain,
vibration,
position)
Reflexes
WNL B/L
(biceps, triceps,
patellar, achilles)
LYMPH
(Choose 2)
Babinski
Romberg
Heel to
shin
Downgoing
WNL
WNL
___Neck
Areas palpated not
enlarged
___Axilla
___Groin
___Other
FEMALE
Vulva No masses, lesions, scars, swelling,
or rashes
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Student Clinician Handbook, 2003-2004
Labia, clitoris,vaginal orifice, and
urethral meatus:
All intact
w/out discharge
Bladder Non-bulging, non-tender
CHEST
MALE
Cervix Pink w/out lesions, discharge,
odor
Uterus Midline, non-tender, firm and
smooth
Pelvis No masses or tenderness
Femoral hernia: Absent B/L
Breasts Symmetrical
Breasts No masses,
lumps, discharge,
tenderness
Scrotum: No masses, swelling,
tenderness
Penis: No discharge
Circ_______ Uncirc________
Prostate: Symmetrical. No
tenderness, enlargement, nodularity
Inguinal canal: No hernia B/L
Comprehensive: >2 bullets from 9 areas Detailed: >2 bullets from 6 areas/ or 12 bullets from >2 areas Expanded: >
6 bullets Problem focused: 1-5 bullets
(*) = See attached notes
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Appendix 10
CO-MANAGEMENT: TEMPLATES AND ETIQUETTE GUIDELINES
In order to facilitate professional and appropriate communications between Bastyr Center
for Natural Health providers and other healthcare providers, we all need to use similar
standards for referral and treatment summary letters. Following this introduction, you
will find copies of a model for a treatment summary letter, a model for a referral-to-aspecialist letter, and examples of both letters.
The following are elements of professional etiquette:
1. It is customary to write a treatment summary letter to the referring primary care doctor
shortly after the first referred visit. If the initial strategy of the case management can
only be summarized after several visits, the treatment summary may be completed after
the 2nd or 3rd visit. This summary letter is applicable to all referrals from primary care
doctors.
2. After you have received written consent from the patient, you should write a treatment
summary to this patient’s primary care doctor even if the patient is seeing you outside of
a referral. This is essential for safe and effective co-managed care.
3. You should periodically send treatment summary updates to the patient’s primary care
provider. The interval of these letters is dependent upon the nature of the case.
3. Treatment summary letters to primary care doctors may not instruct the primary care
doctor in the care of the patient. Treatment summary letters summarize your findings and
management in order to inform the primary care physician. You should not recommend
general screening tests or interventions outside the scope of the referral to the patient or
to the referring primary care physician. You may inquire about the primary care
physician’s intended screening or case management strategies. The language of
treatment summary letters should be deferential; after all, you are seeing “their” patient as
a specialist.
4. If you are the primary care physician writing a letter to a specialist, it is important to
summarize all relevant findings so that the time your patient spends with the specialist is
productive and effective. Your letter should be instructive and should contain copies of
relevant diagnostic reports.
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Today’s date
Dr. name of referring doctor
Address of referring doctor
RE: patient name
DOB: of patient
ICD-9: referred ICD-9 diagnosis
Dear Dr. name of referring doctor,
We thank you for the opportunity to see your patient, Jane Doe, for complementary
naturopathic care at Bastyr Center for Natural Health – Team Care.
HX: Start with a statement of the total number of visits and the dates of the visits. Restate presenting CC, which must be the same as the referred diagnosis. Discuss history
of present illness (i.e. summary of chief complaint attributes). Also list relevant and
associated secondary diagnoses/complaints.
ROS (significant): List significant past medical history as well as pertinent negatives.
PMHX: List significant past medical history
FAM HX: List significant family history
MEDS/SUPPLMNTS: Upon initial visit, list the medications and supplements patient
was taking. List any known allergies to medications in CAPITAL FONT.
PE: Summary of relevant PE findings at first visit
MNGMNT: Summary of case management, including responses to treatments, new PE
findings, and progression of treatments.
RECOMMENDATIONS: Overall summary of patient response to
naturopathic/acupuncture/nutrition treatment and your request for additional referrals if
necessary.
Please contact us if you have any further questions or concerns.
Sincerely,
Supervisor name, ND or LAc or RD
Supervising Faculty
Primary Clinician / Intern name
Student clinician
CC: patient
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13 November 2001
Dr. Primary Care Doctor
1001 1st Ave.
Seattle, WA 98111
RE: Jane Doe
DOB: 1/1/01
ICD-9: 564.1 (irritable bowel syndrome)
Dear Dr. Primary Care Doctor,
I thank you for the opportunity to see your patient, Jane Doe, for complementary
naturopathic care at Bastyr Center for Natural Health – Team Care.
HX: I have seen Jane Doe three times (2/3/01, 3/8/01, and 4/15/01). She first presented
on 2/3/01 with a diagnosis of irritable bowel syndrome (564.1). On February 3rd, Ms.
Doe reported that her IBS symptoms began during the winter of 1999. She experienced 2
episodes of the stomach flu within 1 month of each other. Subsequent to these flu
episodes, Ms. Doe has experienced gastrointestinal problems. She described constant
eructation, sore and irritating pressure in her epigastric area, and flatulence. Her
symptoms present somewhat intermittently without any identifiable pattern. She reported
that she had been tested negative for giardia and H. pylori. She also has had a negative
endoscopy and biopsy. Finally, a 24-hour pH test revealed weakened LES and a gastric
emptying test revealed delayed gastric emptying. Ms. Doe explained that antacids and
doxepin were mildly helpful in temporarily alleviating her symptoms. She also informed
me that various food eliminations and a decrease in caffeine and alcohol were somewhat
helpful. Ms. Doe expressed concern that this past summer, she experienced two episodes
of diarrhea, which was a new symptom for her. Ms. Doe denied stabbing, crampy, or
burning pain. She denied nausea or vomiting. She reported 2-3 bowel movements
weekly that were well formed and without abnormalities. In general, Ms. Doe reported
excellent lifestyle habits. Her diet was sufficient in calories, although very limited in
variety. She reported regular exercise and sleep. Ms. Doe’s primary goal was to regain
normal, asymptomatic digestive function.
ROS (significant): History of dysthymia; currently mild. No significant symptoms
reported with regards to cardiovascular, dermatological, musculoskeletal, urinary, or
reproductive functions.
PMHX: Ms. Doe had a benign breast cyst diagnosed in July 2001. Ms. Doe reported
PMS symptoms for which she recently has been prescribed oral contraceptives.
FAM HX: Mother with HTN, diagnosed at age 45. Paternal grandfather with ulcerative
colitis.
MEDS/SUPPLMNTS: Upon initial visit – LoEstrin 28, B vitamin supplement (50 mg
daily), Calcium supplement (1500 mg daily). ALLERGIC TO ERYTHROMYCIN.
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PE: bp: 100/64, p: 52; reg., t: 98.3, rr: 16. Heart: rrr, no extra sounds. Thyroid: nonpalpable. Abdomen: bs x 4; no shifting dullness, no masses, negative hepatic or splenic
enlargement, mild tenderness to deep palpation of RLQ and suprapubic regions.
MNGMNT: Based upon the presentation of the IBS symptoms and the onset of the
symptoms after repeated viral infections, we presumed that the IBS symptoms developed
as a result of intestinal dysbiosis, decreased intestinal mucosal integrity and an associated
prostaglandin pro-inflammatory imbalance. At Ms. Doe’s first visit, we recommended
oral acidophilus supplementation (HMF Forte), a digestive stimulant, mild laxative, and
carminative herbal tincture (Rumex crispus: Foeniculum vulgare), an extract of licorice
(Glycyrrhiza glabra) for its anti-inflammatory and mucosal healing properties, and an
omega-3 fatty acid supplement. After a month on this plan, Ms. Doe returned on
March 8th , when she reported some improvement. She was having a bowel movement
every other day and was experiencing a concomitant decrease in flatulence. Her
abdominal discomfort was still present, however, it was decreased in intensity. She
reported no change in her eructation. She also reported a 14-day menses after taking the
oral contraceptives for 2 weeks. She was fully compliant with the treatment. Based
upon this response, we recommended that she continue with the current plan with the
exception of the licorice extract, which we discontinued. We recommended the addition
of Filipendula officinalis herbal tincture (gastrointestinal nervine, herbal antacid, and
anti-inflammatory) and a plant-based digestive enzyme supplement. We recommended
that she increase the variety of vegetables and fruit in her diet. Ms. Doe returned in
another month on April 15th. At this visit, she reported some further improvement in her
abdominal discomfort, flatulence and reported that she was not burping as frequently as
previously.
Overall, she estimated her improvement at 50%. Most of her symptoms only occurred
with the consumption of certain foods, namely some raw vegetables, pizza, and chocolate
chip cookies. At this visit, we discussed Ms. Doe’s stress level and determined that,
despite excellent stress management practices; she tended to internalize work stress. At
this point, we surmised that the dysbiosis and mucosal integrity of her intestinal track
were somewhat improved. However, we suspected that her internalized stress and
physiologically caused inflammation from certain foods were triggering increased levels
of CRF and associated IL-1 release. These molecules are known to bind to 5-HT
receptors in the digestive tract causing constipation and diarrhea depending on the
receptor subtype. We further suspected that her symptoms were aggravated by functional
HCl and pancreatic enzyme deficiencies given the preponderance of eructation and the
epigastric discomfort. Based upon these suspected etiologies of her IBS, we
recommended that Ms. Doe continue the acidophilus, omega-3 and pancreatic enzymes.
We made new recommendations for nervine and adaptogenic botanicals
(Eleutherococcus senticosus and Avena sativa) and betaine HCl. Finally, we emphasized
the importance of additional stress management at work and shared some additional
techniques with Ms. Doe.
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RECOMMENDATIONS: It appears as though Ms. Doe is responding well to
naturopathic treatment of her irritable bowel syndrome. We suspect that Ms. Doe will
need additional time for the healing process to continue. We would very much like to
continue to support Ms. Doe with naturopathic medical treatment. An additional referral
for 3 visits to begin in July 2001 and to occur over a time period of 6 months would best
enable us to provide this naturopathic care to Ms. Doe.
Please contact us if you have any further questions or concerns.
Sincerely,
Doctor’s Name, ND
Supervising Faculty
Student’s Name
Student Clinician
CC: Jane Doe
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Date
Doctor Name
Doctor Address
RE: patient name
number: of patient
DOB: patient birthdate
Social Security
Dear Dr.
I am referring ____ to you for further evaluation of symptoms consistent with (diagnosis
or presumptive diagnosis with ICD-9).
Pertinent Hx: List HPI, relevant PMHx, relevant ROS, and relevant FamHx
Physical Exam and Labs: List significant findings
Interventions: List all current medications and supplements. (Include statement
regarding any known drug allergies)
Impression: List suspected rule-outs, requested evaluations, examinations, follow-up.
In regard to evaluation of this patient, please provide us with the following:
_____ a brief written report on findings (with verbal report if necessary).
_____ treatment as indicated.
_____ periodic status reports on the patient if she/he remains under your care.
Thank you for agreeing to see _______. If further information is needed, please contact
Dr. _(ND supervisor)__ at doctor’s phone #. Thank you so much for your help in the
care of this patient.
Sincerely,
Appointment on:____________@_______
Doctor Name
Student clinician name
Supervising Faculty
Student Clinician
CC: Patient
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Dr. GI Specialist
GI Specialist Building
1 1st Ave.
Seattle, WA 98111
November 5, 2001
RE: Jane Doe
DOB: 2/3/50 SS#: 202-20-0220
Dear Dr. GI Specialist,
I am referring Jane Doe to you for further evaluation of symptoms consistent with
abdominal pain (789.00), possibly indicative of chronic appendicitis, carcinoma of the
colon, Crohn’s disease, ovarian cysts, or other space-occupying lesion.
Pertinent Hx: Ms. Doe first presented with abdominal pain on September 22, 2001. She
reported that she had experienced intermittent abdominal pain since March of 2001. The
pain was located in her right lower quadrant. She described it as achy, occasionally
sharp. The pain was noticeably worse prior to menses, in the morning upon waking. She
reported some relief with hot showers. She described associated discomfort in her low
back. She also described a 4-month history of constipation, with one difficult to pass
bowel movement every 3rd day. She denied association of her abdominal pain with
defecation or eating. Her menses is regular every 23 to 26 days. She also denied fever,
nausea, or bloating. Ms. Doe has a long-standing history of GER with ingestion of
certain foods and is status post cholestectomy in 1999 secondary to cholelithiasis. During
my most recent visit with Ms. Doe, on October 3rd, she reported that her abdominal pain
was more frequent (daily) and was worse than previously in the mornings. In a recent
phone call, Ms. Doe reported that her pain had become more severe and more constant.
She reported being awakened by her pain after more than 3 hours of sleep. Sitting up
provided some relief. Other pertinent history includes moderate obesity, cholethiasis
(cholestectomy 2000) with splenic enlargement in 2000 (see enclosed ultrasound report),
and microcytic anemia (diagnosed 9/25/01).
Physical Exam and Labs Physical examination on October 31, 2001 revealed the
following significant findings:
Abdominal examination: normal b.s. x 4 but diminished, no masses, tenderness to deep
palpation of RLQ and pain reported in RLQ upon deep palpation of LLQ, -HSM
Gynecological examination: without abnormalities. Uterus was partially palpable
without tenderness or apparent enlargement. Ovaries were not palpable bilaterally;
however deep palpation did not elicit any discomfort.
Interventions: Ms. Doe has been taking a multivitamin and an herbal lipotropic formula
for a long period of time. On October 3rd, 2001, she began taking Iron citrate (200 mg
elemental iron daily). Ms. Doe has no known drug allergies.
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Impression: I am concerned about the worsening pain pattern that Ms. Doe is
experiencing. I am also concerned about the recent finding of microcytic anemia. In
particular, I would like to rule out colonic carcinoma, appendicitis or colitis. In light of
the worsening symptoms, I have also scheduled an abdominal CT for Ms. Doe on
October 20th , 2001. I will have the written report of this CT faxed to you as well.
In regard to evaluation of this patient, please provide:
_____
a brief written or verbal report on findings.
_____
diagnostic work-up as indicated.
_____
periodic status reports on the patient if she/he remains under your care.
Ms. Doe has an appointment with you on October 28th, 2001.
Your recommendations would be appreciated. If further information is needed, please
contact me. Thank you so much for your help in the care of this patient.
Sincerely,
Lise Alschuler, N.D.
Supervising Faculty
Happy Student
Student Clinician
CC: patient
Encl: Abdominal ultrasound written report of 2/99; CBC with differential of 9/25/01.
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Appendix 11
Naturopathic Treatment of Malignancy Consent Form
In accordance with the Washington state licensing law of naturopathy, naturopathic doctors may
treat malignancy only in concert with an M.D. or D.O.
I, ______________________, request naturopathic care at the Bastyr Center for Natural Health.
(patient’s name)
An oncologist has diagnosed me with _________________________ cancer.
(type of cancer)
I am currently under the care of Dr. ________________________________ (M.D. or D.O.) for
my cancer.
(name of doctor)
I understand that Washington law requires that any naturopathic care that I receive at the Bastyr
Center for Natural Health for the treatment of cancer be rendered in concert with a medical or
osteopathic doctor. My signature below attests to my understanding of this important
relationship between my health care professionals and my commitment to cooperate with my
care providers in this collaborative treatment.
Date
Patient’s Name (Print)
Guardian’s Name (Print)
Patient’s Signature
Guardian’s Signature
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communicable disease outbreak policy,
136
competencies and grading, note, 73
conduct. See code of conduct
confidentiality policy, 76–78
copy machine, 137
CPT. See current procedural terminology
current procedural terminology (CPT),
111–18
A
absence, 15, 40, 41, 42, 43, 44, 45, 52,
106, 107, 116, 215
absence/substitute form, 215
academic advising, 36–38
academic probation, 13, 52
accident or illness, occupational, 134
accident or illness, patient/visitor, 135
advanced preceptorships, 34–35
announcements, 137
D
daily shift check-off evaluation form,
216
department overview, AOM, 11
department overview, ND, 12
department overview, Nutrition, 12
disinfection, 86
dismissal, 45, 74
dispensary, 20, 23, 65, 67, 68, 71, 88,
89, 92, 105, 119, 146, 165, 196
documentation guidelines, 112
documentation guidelines for evaluation
and management services, 263
dress code, 83, 84
dress, hygiene, and personal appearance,
83–85
B
background check, 13, 14, 19
biohazard waste handling, 86
C
case preview protocol, 108–9
case review protocol, 109–10
charting guidelines, AOM, 96
charting guidelines, ND, 97–100
charting guidelines, Nutrition, 101–3
charts. See patient charts
China externship, 35–36
China externship application form, 214
clean needle technique, 86
clinic attendance requirements, 40–42
clinic contract, 10, 13
clinic entry I, ND, 17
clinic entry II, ND, 18
clinic entry, AOM, 16
clinic entry, Nutrition, 18
clinic sanction, 43, 45, 96, 108
clinical competencies, AOM, 142–58
clinical competencies, global, 141
clinical competencies, ND, 160–200
clinical competencies, Nutrition, 201–9
clinical faculty, 210–11
code of conduct, 81
code of ethics, 82–83
co-management templates and etiquette
guidelines, 264–71
E
earthquake response plan, 136
email policies, 78–81
emergency, 14, 39, 40, 41, 42, 43, 51,
52, 72, 81, 107, 109, 121, 122, 123,
125, 132, 133, 134, 135, 136, 138,
146, 165, 166, 214, 215
emergency leave, 43
ethics. See code of ethics
exit exam, Nutrition, 29, 101, 208
external sites, 26, 38, 42, 84
G
grading, 50–53
grading manual, ND program, 54
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grievance policy for patients, 47
grievance policy for students, 47
gynecological cytology services, 127–29
M
malignancy, 129–30
medical abbreviations, 252–55
medical records, 110–11
mid-quarter letter, 51, 53, 54
minors, 120–24
mission of Bastyr University, 2
mission of the Bastyr Center for Natural
Health, 2
H
handwashing, 86
HIPAA policies, 78
hours, 14, 16, 18, 19, 20, 22, 23, 24, 26,
27, 29, 30, 31, 32, 33, 34, 35, 36, 40,
41, 43, 44, 45, 46, 51, 59, 65, 66, 73,
76, 85, 89, 92, 94, 95, 98, 106, 107,
125, 133, 134, 135, 144, 197, 208,
213, 254, 270
hygiene, 83–85
N
naturopathic treatment of malignancy,
129–30
naturopathic treatment of malignancy
consent form, 272
needle policy, acupuncture, 86
I
ICD-9. See international classification of
diseases
immunization, 13, 14, 19, 85, 86, 129
immunization policy, 85–86
inclement weather policy, 76
Incomplete, 41, 46, 49, 51, 52, 107
index of ND patient handouts, 235–39
index of nutrition patient handouts, 240–
44
insurance, 111–18
interim clinic, 30
international classification of diseases
(ICD-9), 113–14
internship evaluation form, AOM, 220
internship/observation evaluation form,
CHM, 221
interpreter services policy, 130–31
interview guidelines, 105–6
IP (in progress), 49, 51, 106, 107, 217,
218, 219, 220, 221, 224, 228
IT acceptable use policy, 81
O
observation evaluation form, AOM, 219
P
parking, 136
patient charts, 94–96
patient contacts form, 231
patient management policies, 110
patient records and related forms, 93
patient scheduling, 119
patient visit procedure, 88–93
performance evaluations, 49
physical exam guidelines, 106
physical exam guidelines for clinical
competencies, ND, 245–51
physical medicine appointment policy,
137–38
preceptor's evaluation of student form,
233
preceptorships, 32–34
prerequisites to enter clinic, AOM, 13
prerequisites to enter clinic, ND, 14
primary clinician mid-quarter evaluation
form, Nutrition, 225
L
laboratory, 125–29
late, 43, 54, 68, 90, 93, 106, 109
loss of credit, 45
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Student Clinician Handbook, 2003-2004
primary student evaluation form, ND,
218
professional conduct, 81
purpose of the Handbook, 10
student preceptorship plan, ND, 229
student promotions committee, 73
student self-evaluation form
(preceptorship), ND, 230
substitute/extra hours, 43
substitution, 44
summary of clinic requirements, AOM,
19
summary of clinic requirements, ND, 23
summary of clinic requirements,
Nutrition, 29
superbill instructions, 103, 104
supervising faculty comments, 89
suspension, 45
Q
qualitative student clinician video
evaluation form, Nutrition, 227
R
Records Release Form, 92
referrals, 119–20
registration for clinic shifts, 38–40
residency program, 138–39
T
telephone contact policy, 131–32
third party reimbursement, 111
S
sanctions, 44
secondary clinician evaluation form,
Nutrition, 222
secondary student evaluation form, ND,
217
sentinel events procedure, 133–35
shift guidelines, 106–8
shifts, 13, 19, 20, 21, 22, 23, 24, 25, 26,
27, 28, 29, 30, 31, 32, 34, 35, 36, 37,
38, 39, 40, 41, 42, 44, 46, 54, 58, 65,
66, 73, 83, 84, 85, 86, 91, 106, 107,
137, 139, 144, 149, 178, 190, 196
student evaluation of preceptor form,
ND, 232
U
unexcused absence, 31, 41, 52, 107, 215
V
vision of Bastyr University, 2
W
warning, 43, 44, 45, 54, 64, 74, 84
275