FINAL Global Module 10-11.pdf - AaronsWorld.com

TABLE OF CONTENTS
TABLE OF CONTENTS 1
I. INTRODUCTION 3
MISSION AND VISION STATEMENTS 3
WELCOME 3
PURPOSE OF THE HANDBOOK 3
II. CLINIC SHIFT POLICIES AND PROCEDURES 4
CODE OF ETHICS 4
PROFESSIONAL CODE OF CONDUCT 5
SCOPE OF PRACTICE AND CONFLICT OF INTEREST 5
DRESS, HYGIENE, AND APPEARANCE REQUIREMENTS 6
REGISTERING FOR SHIFTS/ROTATIONS 7
ATTENDANCE REQUIREMENTS AND GRADES 9
ABSENCES 10
GRADING AND STUDENT PERFORMANCE 12
ON-SHIFT POLICIES, ROLES, AND PROCEDURES 16
PATIENT SCHEDULING AND REFERRALS 23
III. SAFETY, ACCIDENTS, AND EMERGENCIES 25
BLOOD BORNE PREVENTION PROCEDURE 25
NEEDLES 26
ACCIDENT / ILLNESS 27
SUICIDAL/HOMICIDAL PATIENT POLICY AND PROCEDURE 29
REPORTING A PATIENT/VISITOR ACCIDENT OR ILLNESS 33
EMERGENCIES: WEATHER, EARTHQUAKE, DISEASE 34
IV. CONFIDENTIALITY, MEDICAL RECORDS, AND TREATMENT OF MINORS 37
CONFIDENTIALITY 37
MEDICAL RECORDS 42
TREATMENT OF MINORS 47
V. MISCELLANEOUS CLINIC POLICIES: GRIEVANCE, PARKING, FUNDRAISING 50
GRIEVANCE/COMPLAINT POLICIY 50
FACILITIES, EQUIPMENT AND PARKING 51
CULTIVATION AND SOLICITATION POLICY (FUNDRAISING) 52
VI. APPENDICES 54
CLINIC CONTRACT 55
STUDENT HEPATITIS B CHECKLIST 56
STUDENT CLINICIAN ABSENCE / SUBSTITUTE FORM 57
MEDICAL ABBREVIATIONS 58
PATIENT CO-MANAGEMENT: TEMPLATES AND ETIQUETTE GUIDELINES 64
VII. INDEX 71

MISSION AND VISION STATEMENTS
I. INTRODUCTION
THE MISSION OF BASTYR CENTER FOR NATURAL HEALTH
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 MISSION OF BASTYR UNIVERSITY
We educate future leaders in natural health arts and sciences. Respecting the healing power of nature
and recognizing that body, mind and spirit are intrinsically inseparable, we model an integrated
approach to education, research and clinical service.
THE VISION OF BASTYR UNIVERSITY
As the world’s leading academic center for advancing and integrating knowledge n the natural health
arts and sciences, Bastyr University will transform the health and well-being of the human community.
WELCOME
Welcome to Bastyr Center for Natural Health! You are about to begin a very exciting part of your
training at Bastyr University. Bastyr Center for Natural Health, also known as “the clinic" or “BCNH”,
will provide more than 35,000 patient visits this year. The services of each clinical program and the
integration between programs provide some of the best natural medicine care to be found anywhere!
The staff and faculty of BCNH are excited about your entry into the clinical portion of your training
and look forward to working together while you make your unique and important contributions to our
mission.
PURPOSE OF THE HANDBOOK
The purpose of the Student Clinician Handbook is to outline the policies, standards, and requirements
for student clinician performance and conduct in the clinic. The handbook consists of four modules: a
global module that applies to all student clinicians, and three department-specific modules: AOM, ND,
and Nutrition. Student clinicians are responsible for knowing and adhering to all of the guidelines and
requirements described in the current global module of the Student Clinician Handbook as well as
those in the module(s) for their specific program(s).
This handbook governs all student clinicians and supersedes previous editions. The policies and
procedures contained within are subject to change during the year. Changes to policy will be sent by
email to all students in clinical training and will be posted on the university intranet. A signed copy of
the clinic contract found in the appendix of this module is required for OM 4800 AOM Clinic Entry
and ND 6804 Clinic Orientation for students to be eligible to begin clinical training.
The Student Clinician Handbook and other clinic files can be found online. Log in to your student
account, double-click on ‘My Computer’ and then double-click on the N drive which connects to
\\middleearth.prv\bastyr\campus\data\public\clinic. You can also access the same information at this
location: MyBU > Home > Clinical Education > Documents.
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II. CLINIC SHIFT POLICIES AND PROCEDURES
CODE OF ETHICS
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. Individual behaviors also reflect the quality of
health care provided to the patients of the clinics. As individuals and as an institution, we strive for
excellence. The code of ethics provides guidance in achieving excellence. The code may also be found
in the university’s Student Handbook, under Bastyr Center for Natural Health.
Code of Ethics
o The natural health-care practitioner’s primary purpose is to restore, maintain and
optimize health in human beings.
o The natural health-care practitioner acts to restore, maintain and optimize health by
providing individualized care, according to his/her ability and judgment.
o 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.
o The natural health-care practitioner shall recognize, respect and promote the healing
power of nature inherent in each human being. The natural health-care practitioner
shall strive to identify and remove the causes of illness, rather than to merely
eliminate or suppress symptoms.
o The natural health-care practitioner shall educate her/his patients, inspire rational
hope and encourage self-responsibility for health.
o The natural health-care practitioner shall treat each person by considering all
individual health factors and influences.
o The natural health-care practitioner shall promote personal well-being and the
prevention of disease for the individual, community and our world.
o The natural health-care practitioner shall acknowledge the worth and dignity of every
person.
o 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.
o 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. 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.
o The natural health-care practitioner shall conduct his/her practice and professional
activities with honesty, integrity and responsibility for individual judgments and
actions.
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o 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.
o The natural health-care practitioner shall strive to exemplify personal well-being,
ethical character and trustworthiness as a health care professional.
PROFESSIONAL CODE OF CONDUCT
This is the code of conduct for all members of the Bastyr University community. Please see the
University Catalogue and Student Handbook for further information regarding our code of conduct.
The privilege of working in the Bastyr University Clinic Program requires full compliance with all
clinic policies and procedures. Loss of privileges, specified disciplinary actions, or separation from
Bastyr University may be imposed on any University member whose conduct on or off campus
adversely affects the Bastyr University community, in particular when it includes blatant disregard for
the welfare of others.
Fundamental types of misconduct that may lead to suspension or dismissal include:
o Physical and/or verbal abuse, intimidation, or harassment of another person or group.
o Racist and/or derogatory remarks and/or behavior towards another person or group.
o Deliberate or careless endangerment, tampering with safety alarms or equipment,
violation of specific safety regulations, and/or failure to render reasonable
cooperation in an emergency.
o Obstruction or forcible disruptions of regular Bastyr University activities, including
teaching, research, administration, clinic services, discipline, organized events, and
the operation and maintenance of facilities.
o Interference with the free speech and movement of any academic and/or community
members.
o Dishonesty, including provision of false information, alteration or misuse of
documents.
o Plagiarism and/or other academic cheating, impersonation, misrepresentation, or
fraud.
o Theft, abuse of, or unauthorized use of personal or Bastyr University property.
o Use of illicit drugs or being on the premises in a drug or alcohol-intoxicated state.
SCOPE OF PRACTICE AND CONFLICT OF INTEREST
While at the Bastyr Center for Natural Health, a Bastyr University external shift site, or an approved
preceptor shift, the intern clinician’s scope of practice is limited to the scope of practice of his or her
supervisor and shift. An intern clinician may not exceed the scope of practice of the supervising
clinician nor the scope of practice provided as care on the shift.
Note: Students may not refer a patient to their private practice in another licensed profession. This
constitutes a conflict of interest and will result in disciplinary action, jeopardizing the student’s status
in their degree program, up to and including dismissal from the university.
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DRESS, HYGIENE, AND APPEARANCE REQUIREMENTS
The purpose of the dress code is to develop and convey professionalism and to support an attitude of
respect toward patients, the clinic, and natural medicine. All clinical staff, faculty, and students
working when the clinic is open for business must comply with the dress code. If staff, faculty, or
students are not on duty and stop by the clinic when not dressed professionally, they should avoid
lingering where patients are present. All interns must be dressed appropriately for the duration of their
entire shift, including preview and review.
The dress code requires that students wear clean, neatly pressed and professional clothing in good
condition. Clothing should be dressy rather than casual. In compliance with health department
regulations, open-toed sandals or shoes are not permitted in the clinic. Backs, abdomens, and mid to
lower chests should not be revealed by the cut of one’s clothing. Women’s breasts or underwear should
not be visible when bending forward.
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, athletic clothing including casual
T-shirts, polo shirts, tank tops, sweat shirts, sweat pants, shorts, spaghetti strap sundresses and shirts,
cropped tops, and low-riders or low cut pants. Undergarments should not show through clothing. If belt
loops are visible, a belt or suspenders must be worn.
Men are required to wear a shirt and tie unless they are wearing a dress shirt that does not require a tie.
Allowable exceptions to a shirt and tie include turtlenecks, turtleneck sweaters, and mandarin collar or
collarless dress shirts. Wearing medical smocks or surgical scrubs and clean athletic footwear is
allowable on physical medicine shifts in ND clinic only.
Women are required to wear an appropriate top (sweater, blouse, or shirt) and bottom (dress slacks,
pants, or skirts). Skirts and dresses must be of modest cut and length. Clothing should never be tight
fitting or revealing. An appropriate dress or skirt of modest length must cover tights and leggings. No
leggings or tights may be worn alone as slacks or pants.
All clinicians in the Acupuncture and Oriental Medicine clinic must wear a white lab coat of knee
length with lapels over their street clothing as described above. 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.
It is preferable that clinicians have no visible piercing or tattoo. Earrings and modest nose piercings are
the exception. Visible tattoos must be minimal and tasteful, since many patients find them offensive.
Extensive or dramatic tattoos must be covered by clothing, such as long sleeves, wherever possible.
Please be aware of breath and body odors when at the clinic. The Bastyr Center for Natural Heath is a
scent free workplace. Do not wear any scents or perfumes in the clinic. Keep hair, beards, and
fingernails clean and neatly trimmed. Tie or pin back long hair, whether you are male or female. Hair
should not be shocking or outrageous in style or color.
Photo ID badges are required at all times while in the clinic. Some external clinics may specify and
provide their own ID badges that should be worn instead of badges issued by the Bastyr Center for
Natural Health. Consult your site supervisor for specifics.
Dress code adherence is mandatory when representing Bastyr Center for Natural Health or Bastyr
University at external sites or events, unless the site has different dress requirements.
No food or beverage consumption is allowed in the exam rooms. Keep the exam rooms free of nonclinical
personal items. Cupboards are present in the exam rooms to store your belongings.
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DRESS CODE VIOLATIONS
It is up to each individual to follow this code. The clinical faculty, Dean and Associate Dean, or their
designee, will respond to incidences of non-adherence to this dress code on a case-by-case basis.
Violations of the dress code can result in the following:
For a first offense, students receive a written warning and can be sent home for the shift. If sent home,
this shift will count as an unexcused absence. Students will lose all hours and patient contacts for that
day’s shift.
For a second offense, a student will be sent home and fail the shift.
REGISTERING FOR SHIFTS/ROTATIONS
The following information pertains to all students registering for clinic shifts at the Bastyr Center for
Natural Health. For program-specific shift registration requirements, please see the respective Student
Clinician Handbook module for your program.
Bastyr University utilizes two-quarter scheduling. Clinic shift and didactic course registration is
completed for all clinic-eligible students for summer/fall and winter/spring.
Clinicians have the opportunity to request supervisors for their clinical shifts. While every effort will
be made to meet these requests, there are no guarantees that these requests will be met.
Each clinician may be assigned at least one, and could be assigned more, Saturday shifts during each
year of their clinical training. Exception will be made for clinicians who have religious obligations that
prevent their working on Saturday. Primary clinicians are required to enroll in external/offsite shifts as
outlined by their respective program, unless they do not meet requirements. Should a new offsite shift
become available after clinical assignments, the clinic Associate Registrar reserves the right to move
clinicians to the new location, as long as it does not cause any undue time conflicts with didactic
courses, or violate the religious restrictions described above. In addition the clinic Associate Registrar
reserves the right to alter student clinical shift schedules during the year.
It is the responsibility of the student to turn in his or her registration form by the posted deadline. If
registration forms are received after deadlines, shift assignments can be affected and late fees will be
assessed.
SPECIALTY SHIFTS/ROTATIONS
The following are considered specialty shifts, and requests by the clinician are required if he or she is
interested in being assigned to a shift:
ND Clinics:
Diabetes and Cardiovascular Health – Students must send a short email to Dr. Ryan Bradley and/or Dr.
Natalie Freedman explaining why they are interested in participating in this shift. Additional reading
and work outside of the shift time is required, and the shift requires an additional 30 minutes
attendance time due to patient schedule requirements. Additional clinical credit may not be given for
this extra time.
Homeopathy – This rotation is open to both primary and secondary students. Students may request a
two-quarter block or a single quarterly shift. Permission from the Chair of Homeopathy is necessary
for clinicians who wish to pursue the study of homeopathy further and is dependent on space
availability.
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Integrated care shift – This shift is supervised by an MD who has trained in integrative medicine and
focuses on minor surgery and management of other health care issues.
IWC/ND
Students are recommended to complete the AIDS and Alternative Medicine elective prior to selecting
the HIV/AIDS integrated wellness shift. Final assignments are determined in conjunction with an ND /
IWC Supervisor. ND students must be willing to commit to this shift for two consecutive quarters.
The Immune Wellness Clinic shift (IWC) allows low-income people living with HIV/AIDS to receive
free or low cost care at the clinic and discounts at both dispensaries. This program is subsidized by
Bastyr University. To qualify for this program, patients must have gross income less than 200% of the
federal poverty income guidelines. Patients apply by completing applications processed by the
business office. The patients are referred by their community case managers (medical social workers),
doctors, or friends in the program. The Thursday evening IWC shift is an integrated shift involving ND,
AOM, and Nutrition supervisors and students. Case Review integrates all students into a group review
process. The program supports over 150 visits each month.
There are certain guidelines for working with IWC patients:
o All IWC patients are encouraged to have visits in Naturopathy, Acupuncture and
Oriental Medicine, and Nutrition.
o Most patients use this program and its resources responsibly and excessive selfreferred
visits are not allowed. The provider overseeing the care of such a patient
who may be abusing the system is responsible for developing and directing the care
plan.
The IWC program does not pay for laboratory or diagnostic testing. The business office will provide
accurate information to questions about coverage.
ND/AOM– These shifts are only available to dual-track students who are primary-eligible in both
programs. The ND/AOM shift (located in ND Team Care) counts as a patient care shift in the ND
program and the AOM/ND shift (located in AOM Team Care) as an intern shift in the MSA or
MSAOM program.
Research Shift – This shift focuses on patients involved in a research protocol.
IV Therapy – This shift provides general patient care and on provision of IV Therapies to patients. It
is only open to primary eligible students.
Biofeedback – This is the counseling portion of the Integrated Pain Management Shift.
Visceral Manipulation – This shift is open to both primary and secondary clinicians who will provide
both general patient care and their visceral manipulation skills.
Pain Management Shift – This is an integrated AOM/ND(PMed)/NTR/Counseling shift held at BCNH
focused on the treatment of patients who experience chronic pain. Gathering of information associated
with research studies may be part of the student’s duties.
AOM Clinics:
IWC/AOM – Students must have taken the Public Health Issues in AOM course, or must receive
permission of the Associate Dean or AOM/IWC supervisor for this shift.
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AOM/ND – These shifts are only open to dual-track students who are primary-eligible in both
programs. The ND/AOM shift counts as a patient care shift in the ND program, and the AOM/ND as
an intern shift in the MSA or MSAOM program.
Pain Management Shift – This is an integrated AOM/ND(PMed)/NTR/Counseling shift held at BCNH.
Gathering of information associated with research may be a part of the student’s duties.
Offsite/External Clinics:
External Sites – ND and AOM clinicians may be required to do offsite shifts when there are openings
at times the clinician has indicated availability, and the intern meets the requirements for the shift.
EXTERNAL SITES/ROTATIONS
Standard policies on attendance, evaluation of students and instructors, professional behavior, and
discipline apply at all Bastyr external sites. The clinic program supervisor provides the instructor and
student with the forms necessary for documenting these processes. Instructors at external sites know
internal clinic shift procedures, such as case preview/review and documentation guidelines, and are
encouraged to follow these procedures, as feasible to the site. The instructor may develop special
procedures that meet the unique needs of a site. All external site registration occurs during clinic
registration, and some supervisors may require an extra screening step such as a letter of intention,
from the student. Most external sites require additional screening such as documentation and
vaccinations. Some external clinics require an additional onsite orientation. A list of current external
sites is provided to students during the clinic registration process.
ATTENDANCE REQUIREMENTS AND GRADES
All student clinicians will be required to attend at least 80 percent of each assigned quarterly shift,
including clinic assistant, observation, intern, and patient care shifts, in order to receive a grade of
Achieved Competency (AC) or In Progress (IP), for the shift. Hours missed because of holidays and
emergency or other administrative closures do not count against the total quarter’s attendance for the
purpose of assigning a grade, but all missed hours, including university holidays and administrative
closures must be made up. A student must attend at least nine daily shifts for each quarterly shift in
order to pass that shift.
A student who does not attend at least 80 percent of the quarterly shift (two excused absences) will
normally receive a failure for that quarterly shift, lose all hours and patient contacts and the entire
quarterly shift will need to be repeated. Exceptional circumstances resulting in a third absence requires
approval by the supervisor. Please note that students must complete 100 percent of their required
clinical hours before they will receive a recommendation for graduation.
An incomplete grade may only be awarded for documented medical necessity and must meet the
guidelines published by the university. Students must apply to the Associate Dean or clinic
administrator in their respective program in order to apply for a grade of incomplete. See the Bastyr
University Catalog for more information on incomplete grades.
Students will receive a grade of IP (in progress) if they miss any shifts, whether the absence was due to
a holiday, administrative clinic closure or personal absence. Clinic grades of IP will be changed to AC
at the end of the program if a review of the student’s records has shown that the clinic shifts have been
made up.
Clinic grades of IP will be changed to AC at the end of the program if a review of the student’s records
has shown that missing hours have been completed.
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Students will receive a grade of AC (achieved competency) only if they are in attendance for the entire
quarter and all clinical work reflects the required skill level.
Students who are 15 minutes late to their assigned shift will receive a written warning for a first event
and need to make up missed time. A clinic sanction will be given for a second event in the same
quarter. If a third event occurs, the student is eligible to fail the quarterly shift. (For more information,
see page 14, the Sanctions section under Grading & Student Performance.)
ABSENCES
It is the responsibility of every student clinician to inform their assigned supervisor of any absence.
PLANNED ABSENCES
Complete the bottom portion of the Student Clinician Absence/Substitution Form. Complete a separate
form for each shift you will miss. (A sample of this form is included in the appendix on page 57.)
Complete the bottom portion, including your name, ID#, today’s date, date of expected absence, shift,
program, and reason for absence.
Notify the supervisor and have him or her sign in the appropriate space. Primary ND and AOM interns
must secure a substitute to cover their shift and the substitute must sign the form. In the case of dual
primary assignment (two primaries assigned to one treatment room), the supervisor may or may not
require a sub. If a substitute does not sign the form and does not show up for the shift, the student
assigned to the shift is held responsible and will receive sanctions for an unexcused absence. Once the
form is signed by the substitute student, the substitute is responsible for attending the shift.
Once the form is completed, give it to the faculty administrative assistant in room S206 at the clinic,
who keeps it for the quarter.
Primary clinicians are also responsible for contacting the patients who are coming in specifically to see
them. Patient phone numbers are available from the front desk. Ask patients to contact the front desk if
they wish to reschedule their appointments. Primary clinicians must also notify a
secondary/observation clinician of their intended absence.
Secondary/observation clinicians must also secure a substitute to cover shifts, and complete the
required form including signatures. In addition, secondary clinicians must notify the supervisor and
primary student clinician of their absence.
If students are not able to attend their scheduled shifts during the first week of a quarter, an
“absence/substitution” form must be completed and handed in prior to the date of the absence. A
student will automatically receive a grade of failure, and be dropped from the shift if no notification
has been received and the absence extends to the second week of the quarter.
UNEXCUSED ABSENCES
An unexcused absence is defined as failing to notify the scheduled supervising clinical faculty member
of the absence prior to the start of the shift. The first unexcused absence during a term results 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 quarter and the loss of the entire shift’s hours and patient
contacts. The shift will need to be repeated and paid for a second time. Supervising clinical faculty
members may, at their discretion, accept notification of an absence after the start of the clinic shift in
the event of an 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 an unexcused absence
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and assign sanctions. Two failure grades for clinical training shifts automatically place a student on
final probation with eligibility for dismissal from the program.
A substitute intern who is absent for the shift they agreed to cover and fails to notify the clinical
faculty member is also subject to the unexcused absence policy.
Midwifery students must have a substitute available on an “immediate-notice” basis for all shifts
missed due to their attendance at a birth.
EMERGENCY LEAVES
When an emergency or illness prevents students from attending a shift, they must notify their
supervisor prior to the start of the shift.
Notifying the Supervisor:
In the event of an emergency, the intern must notify her or his supervisor. The supervisor may be
contacted by calling the clinic and asking that the supervisor be contacted. In the event the supervisor is
not available, the intern may, 1) leave a voice mail and an email for the supervisor and 2) contact the
Associate Dean/lead faculty member by email regarding the nature of your emergency. If possible, please
provide a substitute for a missed shift. Be aware there may be additional requirements for specific clinical
programs (ND, AOM, Nutrition, or Health Psychology) which are outlined in the program specific
handbook.
SUBSTITUTE/EXTRA HOURS
Students receive full credit for all hours that they substitute for another student. Substitute hours make
up shift hour deficits.
Students should record the substitute/extra time on their regular time sheet under the substitute/extra
hour section. Only four hours may be recorded for any one daily shift.
AOM sub shifts must go on an AOM time sheet. CHM sub shifts must go on a CHM time sheet. ND
sub shifts must go on an ND time sheet. Do not mix AOM, CHM and ND shifts on one time sheet.
The supervising clinical faculty must sign for the hours and patient contacts received on each day.
All patients that clinicians see on substitute shifts count towards the total patient contact requirements
(350 patients for ND students and 400 patients for AOM students). These patient contacts are tracked
on a summary of patient contacts form, separate from those received for their regularly scheduled shift.
Hours that accumulate in the substitute/extra “bank” may not be used to construct a new shift. These
hours are only used to make up shift hour deficits or may be accumulated to meet future deficits.
The clinic registrar will automatically transfer substitute and extra hours into areas showing a deficit of
hours. These changes are documented at your quarterly update.
All interim shift hours are logged on the Interim timesheet. Excess Interim hours count towards sub
hours once all Interim hour requirements are met.
Interim hours (hours completed during the week after the end of the academic/didactic term during fall,
winter and summer terms) must be made up by substituting on another interim shift. You may not use
substitute hours completed during a regular quarterly shift to complete interim requirements.
AOM: You must complete all observation hours, including observation interim hours, prior to
beginning work on your first primary treatment shift. It is important to verify how many hours you
must make up on your observation shifts, and then complete them before you are scheduled to start as
a primary intern.
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GRADING AND STUDENT PERFORMANCE
Clinic grading is an achieved competency system. Each student must receive a grade of achieved
competency (AC) in order to receive credit and proceed to the next shift. The achieved competency
grading system is not a pass/fail grading system. A grade of AC means that all clinical skills for each
level are successfully mastered, commensurate with the student’s current status at the clinic.
In the event that a student receives an evaluation of partial competency (PC) for any skill listed in their
evaluation for that term, they will receive a grade of PC for that shift. A learning contract will be
developed by the Associate Dean/Clinical Lead for the remediation of the shift. The student will have
until the end of the following term (counted as the Friday of the 11 th week) to complete remediation as
outlined in the learning contract. A grade of F may be assigned if the student:
o has received a grade of PC for more that one to three skills
o has failed to achieve a grade of AC for the same specific skill in more than one term
o has a skill deficit that the faculty member does not feel can be remediated within the time
allowed
At the end of the quarter, the periodic evaluations are a reference for the supervisor when completing
each student’s quarterly performance evaluation. The student will receive a performance evaluation
each quarter.
A student can receive the following quarterly grades:
AC - Achieved competency
PC - Partial competency
IP - In progress
I - Incomplete
W - Withdraw
F - Failure
Here is a brief summary of the meaning of each grade. Please refer to the Bastyr University catalog for
the complete grading policy.
Achieved Competency (AC): Students receive an AC upon demonstrating mastery of all the clinical
knowledge, skills and attitudes outlined on the evaluation form commensurate with the student’s
current level in their clinic program, and they have missed no clinic time during the regular eleven
weeks of the clinical academic term.
Partial Competency (PC): To receive a grade of PC, the student will have received an assessment of
PC on one or more of the mandatory skills in their evaluation. The student may be deficient in no more
than three skills which the supervisor feels can be successfully remediated within one term of the
student receiving the grade of PC. The student must meet with the associate dean or program lead
within the first week of the next quarter to create a learning contract. The student will be required to
successfully meet the terms of the learning contract no later than the end of the term after receiving the
PC grade.
In Progress (IP): An IP grade means a student has achieved competency but has missed one or more
weeks during the academic term, resulting in completing less than 44 hours for the shift in question.
When 100 percent of hours and/or patient contact requirements are complete, the grade will change to
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an AC. This change will be completed by the clinic registrar towards the end of the student’s program,
and will not be completed on a term by term basis.
Incomplete (I): Students will receive an incomplete only for medical or other verifiable emergencies.
In order to receive an incomplete grade for a clinic shift, a student must contact the Associate Dean
and provide written documentation of illness or personal emergency. An incomplete grade may only be
assigned after the seventh (7 th ) week in the quarter. The student must be in good academic standing
and will not apply to a student who is failing a class or clinic shift. All incomplete grades not
successfully completed by the end of the third week of the following quarter will convert to a failure (F)
grade. In the event of an ongoing medical or family emergency, incompletes may be extended beyond
the third week of the following term by the Associate Dean or Dean of the program in which the
incomplete occurred.
Withdraw (W): A student officially withdraws by notifying the clinic registration staff, who will then
notify the registrar, supervisors and faculty members. The student must also obtain approval from the
Dean of their program. Withdrawal requests are allowed for documented emergency purposes only and
occur only through the eighth week of the quarter. An approved withdraw allows a student to keep all
patient contacts. Hours completed to date will be used as substitute/extra hours. The only exception to
this is when the student has received a mid-quarter letter identifying areas of deficient competency
prior to a withdrawal, and has not demonstrated that these areas of deficiency are at AC level at the
time of withdrawal. In this case, all patient contacts and hours prior to the withdrawal will be forfeit.
Note: When a student officially drops a shift after the deadline, the result will be a loss of all clinic
credits/hours/patient contacts for the entire quarter shift.
Failure (F): The student does not satisfactorily demonstrate competence as outlined for their level of
training. At the discretion of the Dean or Associate dean, a grade of failure may also be applied in the
event of an egregious infraction of clinic policy that endangers a patient or violates state or federal law.
This results in a loss of all clinic credits, hours, and patient contacts for the entire shift, and will require
a repeat shift at Bastyr Center for Natural Health. The failure of a clinic shift places the student on
academic probation. Two quarterly shift failures will automatically place the student on final
probation. In addition the dean, or their designee, will make a recommendation to the school
promotions committee regarding dismissal from the university. In the event that the student is not
dismissed, a learning contract is developed for the student. The student must successfully meet the
requirements of the learning contract to avoid dismissal.
FAILURE RISK
To provide time to improve their performance, students who are at risk for failing a quarterly shift are
notified verbally and in writing by their supervising clinical faculty of their deficiency. The letter will
make suggestions for improvement and provide a timeline for the student. The notification is made as
soon as the deficiency is evident, preferably mid-quarter, unless the deficiencies are not evident until
after that time. If a student is having difficulty meeting the requirements of their clinical training, they
should seek assistance from their clinic advisor or the associate clinical dean or program lead. A copy
of this letter is sent to the student’s advisor, the program dean or their designee, and to the registrar's
office (for the student’s clinic file). The notification letter will identify each area of concern and will
provide clear guidelines about what is required in order to achieve competency. 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.
AOM: All interns must get a midterm letter for each of their shifts.
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If students wish 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.
GRADING & TIME SHEETS
Clinicians receive a pre-printed clinic time sheet for each assigned shift and are responsible for
accurately entering hours and patient contacts on this form. Supervisors must initial each shift and
patient contact for the student to receive credit. Once the quarterly shift is completed, the supervisor
will assign a grade for the shift. The time sheet and the grade recorded on it are submitted by the
supervisor to the clinic registrar for processing of grades and credit.
Clinicians are required to turn in all original paperwork to their supervisor in a timely manner at the
end of each quarter. The clinic registrar does not accept copies of clinic paperwork. Upon completion
by the supervisor, the registrar’s office records the grades for each shift. A student who fails to turn in
their clinic paperwork does not receive credit for the quarter. Failing to respond to requests to turn in
paperwork may result in an appearance before the student progress committee.
In the event a clinician loses his or her paperwork, the clinician is responsible for recreating the
paperwork with all appropriate signatures. A new form can be obtained from the registrar.
Interim paperwork is due at the end of each interim period. Only one quarter of interim hours entered
on a single form is acceptable.
Completed forms left in the basket outside S206 on the second floor are collected by the clinic
program supervisor and go to the clinic registrar on campus daily. Students should keep copies of all
completed forms and clinic-related paperwork for their own records.
STUDENT PROMOTIONS COMMITTEE
The Student Promotions Committee consists of faculty within a specific school, including the Dean
and Associate Dean or Clinic Lead. This committee evaluates student academic performance of those
students with academic concerns in the previous quarter(s). This committee will look at the entire
academic record of the student and make a determination as to the appropriate course of action. The
course of action can include, but is not limited to, a warning, learning contract, probation, or
recommendation for suspension and/or dismissal from the program. The student should contact the
Vice President of Student Affairs for counseling and advice if they should be called to meet with this
committee.
SANCTION/FAILURE EVENT(S)
If a student commits an actionable violation of clinic policy, the student will receive a written sanction
by the supervisor, with a copy to the Associate Dean/Clinic Lead. At the discretion of the supervisor,
the sanction may result in loss of all contacts and hours on the shift for the day in which the event
occurred. Additional penalties may be assigned by the supervisor. A second written sanction on the
same shift will result in a grade of F with the loss of all hours and contacts for the entire shift.
Student will be issued a sanction when they are found to have violated any of the policies of the clinic,
including but not limited to:
o Breaching patient confidentiality.
o Removing any patient ID information from the clinic.
o Acting in an unprofessional or disrespectful manner at any time, including when offshift.
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o Failing to comply with Blood Borne Pathogen safety policies and procedures, or any
other actions that affect patient, intern, or staff safety.
o Unexcused absence from a clinical shift.
The severity of the sanction will depend on the severity of the offense and can range from loss of
clinical hours and patient contacts, to suspension from the clinic or expulsion from the university. The
involved supervisor and the program Associate Dean, or their designee, will determine the type of
sanction. Sanctions are not grades and are, therefore, 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.
FAILURE EVENT
A failure event results in a loss of credit for the daily shift including hours and patient contacts.
Additional penalty may include a sanction of up to eight additional hours. The Associate Dean must
initial all sub hours used to remediate the failure event on the failure event time sheet, available from
the clinic registrar or associate dean.
MIDTERM/WARNING LETTER
A warning letter is provided to the student by clinical faculty in the event that the student is not
performing up to AC level in any area for which the intern is being evaluated. The letter is provided as
early in the quarter as the deficient performance becomes evident. In the School of Acupuncture and
Oriental Medicine a midterm letter evaluating performance is given to all students, regardless of
academic performance.
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. The following actions will result in a clinic sanction:
o Failure to follow the clinic attendance and absence/substitution policy.
o Failure to follow the clinic policies and procedures as described in the Global Module
Handbook or the school specific handbook.
o Failure to follow the instructions or recommendations of the supervising
doctor/physician/faculty.
o Causing intentional harm to a clinic patient, neglect of a patient’s care and safety, or
any form of verbal abuse.
o Inappropriate behavior or unethical conduct when interacting with clinical faculty,
staff, patients, or students.
o Failure to follow the telephone and email contact policies and procedures.
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 program Associate Dean, Dean or their designee will make a recommendation to the
Vice President for Academic Affairs according to the circumstances of each incident:
o Dishonest conduct.
o Practicing medicine without a license. This includes practicing clinically outside of
school prior to completion of a degree or certificate.
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o Violation of the Bastyr Center for Natural Health code of ethics.
o Breach of patient confidentiality, which includes the removal of any identifying
patient material from the clinic.
o Willful refusal to comply with the instructions of the student’s supervisor, Associate
Dean, Dean, safety officer, or clinic staff.
ON-SHIFT POLICIES, ROLES, AND PROCEDURES
CASE PREVIEW AND REVIEW PROTOCOLS
The following are recommendations to make case preview a better learning and teaching experience:
o Case preview is the first 30 minutes of each four-hour shift. Case review is the last 30
minutes of each four-hour shift.
o Supervising clinical faculty members are responsible for starting and ending case
preview on time. Clinic supervisors and students should be familiar with the day’s
cases.
o Students are required to start on time with all of their cases reviewed in advance of
preview. All lab results and medical records should be in the chart and the students
ready to discuss them.
o The student team from each room presents a brief identification of their patients
scheduled on the shift.
o Patient age, sex and other relevant data
o Chief and secondary complaint(s)
o Then, one room at a time, the primary student clinician will present the purpose of
the days’ visit for each patient scheduled. The clinician should include other
relevant information for each case, such as diagnostic testing and previous treatment
results.
o If this is an ROC, a short summary should be presented of past data pertinent to
understanding the assessment, and the response of the patient to the treatment. In
addition, note future plans. A discussion of that day’s plan should be presented.
o If this is an FOC, a discussion of the complaint should occur that includes possible
differential diagnosis, confirmatory exams and therapeutic ideas.
o All the other student clinicians should be attentive to each case.
o By the end of case preview, all the cases will have been discussed as a group, and the
students will be prepared to start the first scheduled patient’s care.
o 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. Case preview is
valuable educational time to prepare the student clinicians for the day’s patients.
o Case presentations must be concise and completed within six to seven minutes
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CHECK-OUT AND PAYMENT FOR SERVICES
When the patient visit is completed, the primary or secondary student clinician must accompany the
patient to the “Please Wait Here” sign at the front desk for rescheduling and checkout. Be sure to
personally deliver the completed superbill to the front desk staff before the end of the patient’s
treatment. The intern is responsible for ensuring the superbill is accurately completed, with all
diagnostic and procedure codes. Students should not linger at the front desk and should only wait there
if assistance is required for patients with a special scheduling need. No information regarding
diagnosis or treatment is to be discussed outside of the exam room other than that needed to schedule
an appointment. If there is a line of patients waiting, the student should leave the patient at the “Please
Wait Here” sign and return to shift.
All patients must check out at the front desk before leaving the clinic. Student clinicians are
responsible for notifying the front desk of any late patient checkouts.
Students must not discuss fees or payment arrangements with patients. The patient services department,
prior to the patient visit, arranges all payments or discounts on services.
TIME MANAGEMENT
Student clinicians are responsible for beginning and ending patient visits on time.
o A regular FOC last up to 80 minutes.
o Homeopathy FOC’s last up to 110 minutes.
o Nutrition FOC’s last up to 50 minutes.
o An acute FOC lasts up to 50 minutes.
o A regular ROC lasts up to 50 minutes.
o An acute ROC lasts up to 20 minutes.
An “introduction visit” lasts 15-20 minutes. The purpose of this visit is to answer patient questions and
provide general information. No diagnosis or treatment is given. This visit is available in Naturopathic
Team Care only.
As each patient visit is completed, the exam room is organized, cleaned and prepared for the next
patient. All equipment previously used, should be disinfected.
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 provider.
When a patient schedules and is seen for a visit, the length of the visit should not be changed without
the supervising provider’s consent.
CLINICIANS - PRESENCE OR ABSENCE OF STUDENT
Requests by Patients
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. It must be
assumed that the patient has a legitimate reason for making this request. If the request was made to the
student clinician, it is acceptable for the supervisor to clarify this request with the patient. 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. Any special arrangement
requested by a patient must be approved by the Associate Dean or the Clinic Director (ND) after the
first office call.
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CLINICIAN RESPONSIBILITIES - PRIMARY/INTERN STUDENT
Primary student clinicians are responsible for presenting their cases in case preview and review,
directing patient interviews, taking the case notes and assessing the patient both subjectively and
objectively. After collecting this information, students meet with the supervising faculty to discuss the
diagnostic strategy, and once a diagnosis is reached, establish the plan. Primary student clinicians are
encouraged to think through and develop their own strategy and management of the case, although the
supervising clinical faculty makes the final decisions and is responsible for all aspects of case
management. Specifically, primary student clinicians:
o Preview the case with the attending clinical faculty member and secondary student
clinician during case preview before initiating contact with the patient.
o Monitor the electronic patient schedule and physically check the reception area for
the first 15 minutes of a scheduled appointment in the event of a 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.
o Meet the patient in the reception area and escort the patient to the exam room.
Clinicians should explain to a new patient how the clinic operates, how patient visits
are conducted, and how many supervisors and/or observers will be attending the
visit. (From this point onward, the patient is not left unattended, except for the
purpose of providing privacy during disrobing and dressing when indicated by a
procedure, when the student clinicians and supervisor discuss the case in private
consultation, or during the resting phase of an acupuncture treatment.) Make sure to
tell all patients to wait until the clinician returns before climbing onto the
exam/massage table. Additionally, do not leave patients with limited physical or
mental capacities unattended for more than brief periods of time. Young or
profoundly mentally handicapped patients must not be left alone in the treatment
room at any time.
o Take 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 for the appropriate
section on the progress form. Draw a single line through any corrections and initial
the correction. Do not scratch out any part of the chart notes.
o Charts must be completed within 24 hours. Any unfinished charts including
unfinished chart notes must be returned to Medical Records one hour after shift, or
checked out with your name and your clinic location noted.
o Carry out your supervisor’s instructions with respect to interviewing the patient,
performing a physical exam, diagnostic studies, and making referrals and treatment
plans.
o Familiarize the secondary student clinician with their style of case management, and
direct/support the secondary student clinician’s role as an observer and facilitator.
o Sign the chart when it is completed, fill in the summary of patient contact “health
data and medication list” forms on the inside cover of the chart, make certain that
the superbill is completed correctly, including CPT and ICD9 codes, and obtain the
supervisor’s signature on all forms and case notes.
o Recommend that the patient is rescheduled after consultation with the supervisor.
For the Naturopathic Team Care clinic, recommend that the patient is rescheduled at
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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. In the Acupuncture or CHM Team Care clinics, attempt to
schedule on a shift with the primary intern unless specifically instructed otherwise
by the supervisor.
o Follow-up by telephone with the patient, with supervisor approval, when there is a
cancellation or no-show for a scheduled visit (both FOC and ROC), to discover why
the patient was unable to come in, determine 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. Major changes or alterations to treatment plans should only be
made during a patient care visit. 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 faculty. (Patients
appreciate personal care and interest shown in their health care.) Check with the
reception staff before proceeding to contact a patient as their reason for absence
may already be known. Chart all phone contacts on a progress note that is signed by
the supervisor.
o Have the time sheet and summary of patient contacts signed off by the
supervisor/clinical faculty at the end of each shift.
o Properly drape patients and pull blinds when patients are to change into a gown.
o Become familiar with clinic resources, such as patient protocols, therapeutic
notebooks, forms, etc.
o Only practice modalities in which coursework has been completed and that
supervisors have approved (i.e., utilizing cranial sacral therapy and specialized
techniques such as the use of tuning forks on acupuncture shifts should only occur
on shifts when the supervisor is also proficient).
IMPORTANT: No treatment modality is applied, supplement recommended, nor instruction
given to the patient without the prior approval of the supervisor. This is practicing medicine
without a license and sanctions would be placed on the student.
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CLINICIAN RESPONSIBILITIES - SECONDARY/OBSERVING STUDENT
Secondary student clinicians have an observer/facilitator role. It is their responsibility to discuss with
primary student clinicians on each shift exactly what role they are to take during the patient visit.
Specifically, secondary student clinicians must:
o Become familiar with each case on each shift before case preview.
o Make certain that the exam room is in order and that all the necessary supplies are in
the room. In the Naturopathic Team Care clinic, there is a list of supplies for each
room in the cabinet above the sink. Insure that the paging telephone volume is at an
audible level.
o Attend case preview to provide input on each case with the primary student clinician
and supervising clinical faculty.
o Oversee the dispensary care, entering all dispensary items on the prescription form.
Obtain supervisor’s signature on the form, seeing that the date, item, and refill
section are complete. In Naturopathic Team Care, make a copy of the prescription
form for the chart. Secondary clinicians also should take the completed and signed
forms to the CHM dispensary (AOM or CHM) or give the original completed and
signed form to the patient (ND).
o At the conclusion of the office visit, accompany 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. In the event there is a patient being seen by all available Patient
Services Representatives (PSRs), the patient should be taken to the privacy sign
near the front desk.
o Instruct the patient that they will have to obtain and pay for their dispensary items
separately from the visit fees. The secondary student should also direct the patient to
the dispensary.
o Make certain that the room is cleaned and disinfected and ready for use by the next
patient or shift.
o Attend case review during the last half-hour of the shift.
o At the end of the shift, is responsible for having the time sheet and summary of
patient contacts signed off by the supervising clinical faculty.
o Anticipate the paper work that needed on a shift and have it ready: release of records,
diet diary, clinic referral form, etc.
o Complete all information on the “records release form” and have patient sign and
date the form, and when complete obtain supervisor’s initials before copying for
chart and forwarding to Medical Records. Note the name of the requesting primary
clinician on the form.
o If a patient has a second appointment in another department following your
appointment, personally take the patient’s chart to the practitioner or clinician with
your chart notes included and give a brief update to the supervisor or clinicians.
IMPORTANT: No treatment modality is applied nor instruction given to the patient without the prior
approval of the supervisor.
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SUPERBILL INSTRUCTIONS
Listed below are the fields that must be reviewed and completed by students and/or supervisors for
each patient visit.
Provider Name: Clearly print the supervising provider name and have the supervisor sign the
bill.
License #: Clearly print the license number of the supervising provider.
Department: Circle the department and/or program that saw the patient.
Patient Information: Make sure that the completed information is correct, and complete any missing
fields.
Name: Patient’s legal name, printed legibly. Do not use nicknames.
Date of Birth: Verify that the date of birth written on the superbill and patient chart match.
Date of Service: Verify that the date of service is correct.
ICD-9 Codes: List each ICD-9 code in descending order of priority or relevance as related to the chief
presenting illness. Only list four diagnoses on the superbill even if the chart notes indicate more than
four diagnoses. A list of common diagnoses with ICD-9 codes is located on the back of the superbill. If
a diagnosis is not on the back of the superbill, consult the on-line diagnostic support program to find
the correct code. In the event that the case is a referral from a gatekeeper from a third party payer, the
approved diagnostic code given by the gatekeeper must be listed first. For AOM providers, list only
the approved diagnostic code. In the event of a personal injury claim, list only the billable diagnostic
codes.
AOM: Use only the diagnosis code for the complaint or complaints being treated at that contact. Be
sure to prioritize pain codes when applicable. For personal injury claims and insurance claims, treat
and code for the complaints that were approved by the payor.
Procedure CPT Codes: Circle all procedures 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.
Version: Check version date at lower right corner to ensure using the latest revision. In the event you
believe you do not have the latest version, contact the Medical Records Office to obtain the most up to
date version of the superbill.
INSURANCE AND CODING
Bastyr Center for Natural Health participates in third party reimbursement systems. All providers at
BCNH, including residents, are credentialed for this purpose. Interns are required to be aware of the
insurance status of the patients they work with, and consult with their supervisor regarding the proper
coding of superbills generated for a patient resulting form each contact.
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DOCUMENTATION GUIDELINES (DG)
Bastyr Center for Natural Health uses documentation guidelines for evaluation and management
services as agreed upon by CMS and the AMA. The clinic’s medical record instruments accurately
model the principles of these guidelines, including the clinic ROS and PE forms. Summaries of DG
appear at the corresponding location in these instruments for the clinician’s convenience. Clinicians are
to ensure that each patient’s medical record complies with these guidelines at each visit. In accordance
with the documentation guidelines for evaluation and management services, proper medical records
keeping include:
o History of Chief Complaint (CC), Secondary Complaint (SC) and Tertiary Complaint
(TC) if applicable.
o History of Present Illness (HPI). Include pertinent elements of location, quality,
severity, duration, timing, context, modifying factors, and associated signs and
symptoms.
o Pertinent elements of Past, Family, and/or Social History (PFSH).
o INTERNATIONAL CLASSIFICATION OF DISEASES (ICD-9)
o Bastyr Center for Natural Health 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.
During each patient visit, the clinician is responsible for choosing the correct ICD-9 code for the visit,
with supervisor approval, and recording it in the medical record and on the patient billing form.
Instructions for choosing ICD-9 codes are included in reference texts- hard copy or on-line. Important
principles for choosing ICD-9 codes include:
o Scope of practice.
o Identifying the most specific code available for the patient's condition.
o The first diagnostic code referenced on the billing form must describe the primary or
most important reason for the care provided. This is the Primary Diagnosis.
o The ICD-9 code chosen must be consistent with and substantiated by information
recorded in the subjective, objective, assessment, and plan sections of the patient’s
written record.
o For more detailed information, please refer to Documentation Guidelines for
Evaluation and Management Services in the appendix.
INTERPRETER SERVICES POLICY
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) exclusion from or denied access to clinical services. The key to providing equal
access for the LEP client is to ensure that the service provider and the LEP client can communicate
effectively. 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.
A health care provider is required to obtain informed consent prior to commencing treatment. The
clinic’s Informed Consent form is in English. It is imperative that an interpreter translate this form in
22

its entirety to the LEP patient, so that the patient is able to give informed consent to treatment (or nontreatment).
Consent given by the patient’s signature is on the Informed Consent form.
In order to meet the guidelines for services provided to LEP patients by Bastyr Center for
Natural Health providers, there are several interpreter options:
While the provider cannot require a patient to use family members or friends as interpreters, a family
member or friend may be 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 compromise of patient’s confidentiality by the use of a family
member or a friend as an interpreter occurs if discussing highly sensitive areas, such as HIV/AIDS,
sexually transmitted diseases, drug and alcohol treatment and mental health issues. Given these
guidelines, the supervising faculty provider must assess compromising the confidentiality or
effectiveness of services by a patient using a family member or friend as an interpreter. Pursue other
options for interpreters if confidentiality or effectiveness of services is deemed compromised.
A student proficient in the patient’s language and in the English language and who is familiar with
medical terminology is 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 is available to provide interpretation and translation for patients. This
service is 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 (ADA), all clinical
service providers are required to provide sign language interpreters for all deaf persons. The cost of
these interpreters is the responsibility of the clinic and in some cases shared with the patient’s health
insurer.
PATIENT SCHEDULING AND REFERRALS
SCHEDULING
Student clinicians are encouraged to bring in their own patients through community education, public
talks, participating in wellness clinics, health fairs, and talking to friends. Students may also review
past clinic schedules and call patients, with permission from their supervisor.
When a patient needs to be referred to another student clinician, because the attending student clinician
is moving to another shift, an external clinic, or is graduating, the attending student clinician must
facilitate a smooth transition to a clinician on the same shift or to another shift where the attending
student clinician will be on duty. This decision is made with the agreement of the supervisor on the
original shift, while considering patient scheduling needs, insurance coverage, and specialty care that
may be indicated. All patients schedule through Patient Services Representatives. Student clinicians do
not make their own scheduling commitments.
The front desk has a system of scheduling FOC’s that is fair for everyone. Student clinicians may not
make any requests to restrict FOC assignment in their rooms.
If arranging an appointment for a patient, students need to have the patient call to schedule an
appointment. Students must never schedule appointments. It is fine to arrange tentatively with a patient
regarding a time to come in, but the patient must actually contact the front desk to schedule the
appointment. Students must have patients scheduled during regular clinic shift time.
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REFERRALS
Patient Referral To BCNH
Clinicians should show appreciation to physicians who refer patients to BCNH with typed thank you
letters after the FOC. When the referred patient has completed several visits (3) or after pertinent
diagnostic or therapeutic outcomes are achieved, the clinician then should send another letter to the
referring physician, summarizing the patient’s visit and/or treatments to date. All correspondence must
be approved and signed by the supervisor.
Patient Referral Outside BCNH
To refer a patient to a provider outside of BCNH, a typewritten letter must be completed by the
primary or secondary student clinician. This letter should follow the standards of a professional
referral letter including the patient’s identifying information, the presenting complaint and other
relevant subjective information, any objective findings, the assessment or rule-outs (differential
diagnosis, depending on the scope of the supervising clinical faculty member), the reason for the
referral, and what treatments, tests or diagnostic procedures are to be performed (again within the
scope of the referring supervisor). The letter should indicate whether or not the recipient provider
should institute treatment as he or she sees appropriate, or whether he or she should consult with the
referring supervisor first. This letter must be signed by the referring provider. It must be photocopied,
with the copy placed in the chart. The original is sent with the patient to be hand delivered or is mailed.
Templates and sample letters are in the appendix of this module or are available from your supervisor.
Intra-clinic Referrals
Student clinicians are encouraged to consider referrals to other departments within the clinic. All such
referrals require an intra-clinic referral letter (see templates and examples in the appendix of this
handbook), completed and signed by the supervisor. The clinicians / supervisor teams are encouraged
to write treatment summary notes at the conclusion of their evaluation or treatment to the referring
supervisor and clinicians.
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III. SAFETY, ACCIDENTS, AND EMERGENCIES
SAFETY
Everyone in the clinic is required to follow the guidelines for universal precautions against infectious
diseases, safety standards, and sterile technique standards. Please review these guidelines.
HAND WASHING AND DISINFECTION
All students and supervisors are required to wash their hands with soap and warm water for 20 seconds
then rinsing thoroughly and drying the hands before and after every patient visit, before and after
performing PE, and any clean or sterile procedure. Disinfection of surfaces (exam tables, equipment,
sink and countertops, lamps, etc.) must be performed between each patient and at the end of shift.
Refer to infection control manual located in the lab for details. Chemical hand sanitizing stations are
located throughout the clinic for use when water is not available.
BLOOD BORNE PREVENTION PROCEDURE
o Wipe all working surfaces down with germicide before and after working with (or
possible exposure to) blood, body fluids or tissues (urine, vaginal fluids, semen,
stool, etc).
o Wear a ¾ length buttoned lab coat when in the acupuncture clinic, or handling or
testing blood or body fluids (even a urine dipstick or vaginal wet prep).
o Dispose of ALL SHARPS (lancet, vacutainer needles, syringes, etc.) in a puncture
resistant SHARPS container.
o Make sure you have EVERYTHING you need (bandaids, gauze, alcohol, Sharps
container, tourniquet, needle, holder, acupuncture needles etc.) in front of you
before starting venipuncture or other invasive procedure.
o NEVER be more than an arm’s length away from a SHARPS container when using
any kind of sharp (needle, lancet, acupuncture needle etc.).
o NEVER walk or turn with an acupuncture needle, syringe or other sharp in your hand.
o NEVER (under any circumstance), recap the needle on a syringe or reinsert an
acupuncture needle into an insertion tube after using it. Even one handed recap is
strictly forbidden.
o NEVER unscrew needle from hub of syringe or vacutainer holder. If it is stuck,
throw out entire apparatus. (average cost is $1.00)
o All non-sharp biohazard items (items exposed to blood or body fluids like urine
dipsticks or bloody gauze) are thrown away in BIOHAZARD (red) BAG, not sharps
containers.
o NEVER put or stuff anything into already full sharps container.
o When Biohazard bag or Sharps container is ¾ full, close it, tape it shut and dispose
of appropriately.
o When in doubt about any of these procedures, ask your supervisor.
25

NEEDLES
NEEDLE STICK OR EXPOSURE INCIDENT
If an incident occurs:
Have someone notify your supervisor who will arrange for another clinician to take over patient care.
Wash the injured area with soap and warm running water for at least two minutes. Squeezing the
wound does not provide any protection.
During clinic hours contact the resident physician on call at 206-834-4100. If after clinic hours,
contact the physician on call at 206-200-7067. If no answer, call the BBP officer at 206-422-8763.
You must talk with a physician within a half hour of the incident.
Provide details and information regarding any other person involved to your supervisor while
completing the incident report. The BBP officer will contact the source person regarding provision of
serum for testing at no cost to them.
The doctor on call or the BBP officer will order blood tests for HIV status, Hepatitis B and Hepatitis C
to be done within 48 hours. Repeat testing will be done at 6 weeks, 3 months and potentially at 6
months, all at no cost to you.
Decisions as to whether you need referral to an emergency room for prophylactic treatment against
HIV need to be made within 30 minutes. Exposure to Hepatitis B or C needs to be addressed within
one week of exposure.
All information and reports will be kept in a locked file in the office of the BBP Officer, separate from
your medical file. Copies will be provided to you upon request. Copies of the source person’s tests
will not be provided.
External sites may have their own policy, which should be observed. The incident report and followup
testing should occur through BCNH.
For more information, contact the BBP or Safety Officer.
CLEAN NEEDLE TECHNIQUE AND BIOHAZARD WASTE HANDLING
Students are responsible for knowing the OSHA/WISHA guidelines for blood borne pathogens and are
required to view a training video and sign a document acknowledging that they understand these
guidelines. Please follow the clinic policies for handling biohazard materials by placing disposables in
the biohazard bags located in each exam room. Immediately take reusable instruments to the
appropriate collection site for cleaning and sterilization. Biohazard materials include all supplies and
instruments exposed to 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.
ACUPUNCTURE NEEDLE POLICY
Acupuncture needle counts occur prior to any treatment, and the number initialed by the intern before
insertion. Interns must record any needles added or removed during the treatment. After all needles are
removed, interns must make a final count and, along with the supervisor, initial it. This information
must be recorded on the chart notes for every visit.
Any lost needle requires the attention of the supervisor. When a needle is lost, the garbage must be
flagged and deposited in the blood borne pathogens collections “box.” The laundry from the room
26

must also be flagged. A special notice alerting the janitorial crew to the lost needle in the room must be
posted on the door. On rare occurrences, it is possible a patient will take a needle home that dropped
into a pants cuff or elsewhere in clothing. The supervisor makes a decision about whether to call the
patient and alert him or her to this possibility. The supervisor records “Lost Needle” incidents and
notifies the Associate Dean for AOM Clinical Education immediately. The Associate Dean will record
the incident and send a copy to the clinic registration staff for the student’s record. Any pattern of
occurrences of lost needles will result in clinical sanctions. If a needle is found to be related to a
specific room or shift, clinical sanctions for the clinicians in that room can result.
All Practitioner Care acupuncturists working at Bastyr Center for Natural Health will be alerted to this
policy and the clinic’s concern. The clinic director is notified if needles are found, in order to initiate
proper feedback.
ACCIDENT / ILLNESS
REPORTING AN OCCUPATIONAL ACCIDENT/ILLNESS
This procedure is for any occupational injury or illness occurring to a student clinician, staff, or faculty
member on the clinic premises or caused by the working environment.
IN CASE OF STUDENT ILLNESS
Notify the supervisor.
The student shall be seen by a provider of their choice as needed (at the clinic or elsewhere).
IN CASE OF ACCIDENT
Notify the supervisor.
In the event of an accident the intern or observer immediately notifies their clinic supervisor. In the
event their clinic supervisor is not available, the intern should notify the nearest clinic supervisor, the
associate dean, or clinic lead for the program. The supervisor immediately determines the nature of the
emergency and if necessary calls 9 - 911. If the supervisor is able to safely do so, they should begin
provide emergency care for the patient. The student clinicians should follow all instructions from the
clinic supervisor during the emergency.
The front desk is responsible for the following:
o Furnishing an Occupational Illness/Injury Report form to the provider/supervisor.
o Arranging for an exam room.
o Contacting appropriate emergency responders per provider’s instructions.
The supervisor and provider will begin appropriate paperwork with the employee as soon as possible
following the accident. The supervisor will forward the paperwork to the clinic safety coordinator
within 24 hours of the incident. The Medical Director, Director of Facilities and Safety or a designated
administrator will continue the evaluation process.
The emergency transport of a patient will be a 911 vehicle. Students, faculty or staff may not drive a
patient to the emergency room in a personal vehicle.
27

IN CASE OF A SENTINEL EVENT
A sentinel event is an unexpected occurrence involving death, physical or psychological injury, or the
risk thereof. “Sentinel” events signal the need for immediate investigation and response.
The front desk, once notified, is responsible for the following:
o Paging the clinic lead for that program.
o Arranging for exam room.
o Furnishing the Occupational Illness/Injury Report form to the provider/supervisor.
o Contacting an appropriate emergency responder per instructions from provider.
The following administrators must be notified immediately:
Paperwork requirements:
o Clinic Director/Medical Director.
o Practice management manager.
o Clinic facilities manager.
o Program lead / Associate Dean(s).
o The supervisor or provider must complete the Occupational Illness/Injury Report
form, including: Date, time, and place of incident.
o Complete, detailed description of incident, including any objects involved.
o Nature of incident.
o Basic cause and any contributing cause(s).
The Medical Director, Director of Facilities and Safety or their designee completes the investigation of
events, conducts interviews with all persons directly involved, and presents an evaluation to the
clinic’s Safety Committee, which is responsible for:
o Evaluation of Review.
o Developing action plans and establishing timelines for completion, including but not
limited to the documentation of response to the incident, identification of
deficiencies, suggestions for improvement(s) to the response, and writing
recommendation(s).
o Sending the findings to the supervisor/ provider directly involved, the program
coordinator, clinic director, and practice management manager.
The OSHA 2000 Log and Summary form must be completed for each event. This is the responsibility
of the Director of Facilities and Safety or the director’s designate. A copy of all paperwork is
forwarded to the Bastyr University Health and Safety Office on campus.
Contact the Medical Director and Director of Facilities and Safety immediately in the event of serous
injury/illness or fatality. All fatalities, or if it is expected someone will die of their injury/illness, must
be reported to Labor and Industries within eight hours of the event or first knowledge of the event.
The Medical Director or Director of Facilities and Safety is to accompany the Regulatory Agency
representative and assist during the investigation. In such an event, leave the area untouched. Photos
of the scene are required to record the environment at the time. Pertinent instructions will be given
when the Medical Director and Director of Facilities and Safety are notified.
28

SUICIDAL/HOMICIDAL PATIENT POLICY AND PROCEDURE
As of January 19, 2007, it is the policy for all health care providers at the Bastyr Center for Natural
Health and providers at the Bastyr University campus and clinic to follow the procedure listed below
when any patient presents with suicidal ideations, or might otherwise be a hazard to self or others. If a
clinic supervisor determines that further evaluation must be made, evaluation may only be made by a
mental health professional. A MHP is defined as a psychologist, therapist, or mental health
professional designated by the clinic administration as qualified to make this determination. Please see
the flow charts below.
Life contracts are not effective and are not used.
29

SUICIDAL/HOMICIDAL PATIENT PROCEDURE
Who
Does What
Patient 1. Expresses suicidal ideation
Student/Intern 2. Reports suicidal/homicidal ideation to supervisor
Supervisor 3. Interviews patient and assesses the seriousness of the situation, determining if
the patient is a hazard to self or others.
4. If the patient is deemed to not be a hazard to self or others by the supervisor, go
to step 5. If the supervisor believes the patient may be a hazard to self or others,
go to step 10.
5. Determines if the patient is under care of a health care professional. If yes go to
step 6. If no, go to step 9.
6. Refer patient to current healthcare professional, noting referral in faculty
member’s comment on progress note.
7. Approve treatment.
Student/Intern 8. Complete approved treatment, charting referral to current health care
professional in plan.
Supervisor 9. If patient is not under care of a mental health professional, refer patient to
mental health professional for follow up. If the patient does not have mental
health resources, include referral to the King County Crisis Line 206.461.3222.
Supervisor
10. If the supervisor determines that the patient is a hazard to self or others,
determine if there is a mental health provider on site at the clinic. If yes go to
step 11. If no go to step 13.
11. Request immediate assistance from on site mental health provider.
On Site
Mental Health
Professional
Supervisor
12. Evaluates patient and determines best course of action. This may include but is
not limited to calling for immediate assistance from emergency providers,
referral for crisis intervention or referral back to supervisor to continue
treatment.
13. Calls 911 to report a patient that may be at risk of doing harm to self or others to
get assistance.
30

FLOW CHART FOR REVISED SUICIDAL/HOMICIDAL PATIENT PROCEDURE
Patient expresses
suicidal/homicidal
ideation
Student/Intern
reports
suicidal/homicidal
ideation to
supervisor.
Patient answers "yes" to any of the
following Questions:
1. Do you have a plan for how you would
harm yourself/others?
2. Do you know when you would harm
yourself/others?
3. Do you have the means to carry out
this plan?
4. Do you have a history of a suicide
attempt/ harming others?
Supervisor
interviews patient
and assesses
the seriouslness
of the situation.
Continue
treatment.
NO
Is patient hazard
to self or others?
Yes
Unsure
Patient must be
seen immediately by
mental health
professional.
Is patient under
care of mental health
professional?
Mental health
professional on
site?
Yes Yes
No No
Request patient to
contact mental
health
professional.
Refer to mental
health
professional, or
the King County
Crisis Clinic at
(206) 461-3222.
Request immediate
assistance from on
site mental health
professional.
Call 911.
Someone must
remain with
patient.
31

EMERGENCY PROCEDURE PROTOCOL FLOW SHEET
Is 911
required?
(if in any doubt,
call them!)
YES
Dial 9 – 911. Don’t hang
up until operator instructs
you to do so.
If this a Blood-Borne Pathogen Incident
(exposure to someone else’s bodily fluid)
follow this procedure and the Blood-Borne
Pathogen Flow Chart located in each exam room.
Is this a potentially
dangerous situation
involving a violent or
threatening individual?
NO
Call the clinic Emergency Phone
at 206-200-7067. Follow their
instructions and notify them
whether 911 has been called.
YES
Use paging system or ask
Appointment Desk to do so:
“Paging Dr. Armstrong. Please
call PHONE EXTENSION or
report to LOCATION.”
If no response within 30 seconds,
page the on-call resident.
If no response within 30 seconds,
send someone to physically locate
a faculty member, resident,
or other ND.
If no response within 1 minute, send
someone to physically locate
“Dr. Armstrong”
(a resident, ND, or Facilities/Security staff)
Fill out an INCIDENT REPORT form
immediately after the incident, while it’s
fresh in your mind. Forms are in each
Review/Preview room or at the Appt. Desk.
Submit the form to the Clinic Safety
Coordinator within 24 hours.
`
32

REPORTING A PATIENT/VISITOR ACCIDENT OR ILLNESS
This protocol applies to any injury or illness occurring on the clinic’s premises or as a result of clinical
services or a product purchased from the Bastyr Dispensary or the Chinese Herbal Dispensary.
IN CASE OF ILLNESS/ACCIDENT ON THE PREMISES OF THE CLINIC
The front desk should be notified and is responsible for the following:
o Arranging for an exam room.
o Furnishing an Incident Report form to the provider of record. The provider of record
completes the top portion of the form and forwards the paperwork to the clinic
safety coordinator within 24 hours of the incident.
o The Director of Facilities and Safety is responsible for contacting the university’s
liability insurance company.
o The Director of Facilities and Safety shall copy all paperwork to the clinic director
and practice management manager within 24 hours.
o The emergency transport of the patient will be a 911 vehicle. An emergency vehicle
should be called by the provider making the initial emergency assessment or her or
his designee
IN CASE OF INJURY FROM OR ADVERSE REACTION TO ANY PRODUCT PURCHASED FROM THE CLINIC
Dispensary staff should notify the supervisor or clinic lead to discuss the event with the patient.
The supervisor is responsible for the following:
o Determining the extent of the problem; refer to the emergency manual located in the
Clinic laboratory.
o Referring patients to a provider, if necessary, to discuss the specific nature of the
problem.
o Either the dispensary staff and/or the supervisor is responsible for the following:
o Completing the top portion of the Incident Report form.
o Forwarding paperwork to the Medical Director within 24 hours of the incident.
The following administrators must be notified immediately:
o Medical Director.
Paperwork requirements:
o Practice management manager.
o Clinic facilities manager.
o Program Lead / Associate Dean.
o The supervisor or provider must complete the top portion of the Incident Report form,
including:
o The date, time, and place of the incident.
o A complete detailed description of incident, including any object(s) or machinery
involved.
33

o The nature of the incident.
o The basic cause and any contributing cause(s).
The Medical Director, Director of Facilities and Safety or designees is responsible for the following:
o Completing the investigation of events.
o Conducting interviews with all persons directly involved.
o Presenting an evaluation to the clinic or campus Safety Committees, which is
responsible for reviewing the evaluation, developing action plans and establishing
time lines for completion, documenting the response to the incident, identifying
deficiencies, suggesting improvement(s) to the response and writing
recommendations.
o Sending its findings to:
o The supervisor/provider who was directly involved.
o The clinic program supervisor.
o The Medical Director.
o The Director of Facilities and Safety
o The Director of Facilities and Safety will follow up, as recommended by the
committee.
o The Medical Director shall contact the patient as deemed necessary to ensure patient
satisfaction.
o Copies of all paperwork will be forwarded to the Bastyr University Health and Safety
Office on campus.
EMERGENCIES: WEATHER, EARTHQUAKE, DISEASE
INCLEMENT WEATHER POLICY AND PROCEDURE
In the event of severe inclement weather conditions, Bastyr University President and the Medical
Director will together determine whether it is indicated for clinic to close. Closure will occur only in
the event of extremely severe weather conditions. There will be every effort to keep the Clinic open to
meet the needs of the clinic’s patients as long as it is safe to do so.
A decision to close will put the following closure procedures into effect:
For all clinic closures, the status of both the clinic and campus will be posted on the
www.schoolreport.org website, which is the source of TV and radio reports.
Closure information for both the campus and clinic is on Bastyr University’s weather message line at
(206) 274-1213 by 6 a.m.
The clinic’s public voicemail system (206) 834-4100 will be up-to-date with closure information by
7:30 a.m. Clinic staff members will come in to call and inform scheduled patients of clinic closure and
will post signs on clinic doors.
Closure decisions made during clinic business hours will follow the following:
o Signs will be posted immediately on clinic doors
34

o The clinic’s master voicemail message will be modified immediately
o Scheduled patients will be called and informed of closure
o People at the clinic will be notified by others in the building
o Campus will post signs for students near the cafeteria and at the DART bus stop
Decisions to close on a Saturday will follow the same procedures.
In the event of a power and/or phone outage, communications with employees, patients, and students
will be limited. Clinic staff will post signs and do their utmost to have someone available to meet
anyone who comes in.
In general, off-site/external shifts will also close when the clinic closes due to inclement weather. Any
shift hours missed due to inclement weather will need to be made-up. Additionally, a site supervisor
may close a site at their discretion. Off-site clinics will also close when the host institution is closed.
Contact the ND External Site Coordinator at (206) 834-4188 for the latest information on ND external
shifts. Contact the Associate Dean in the School of Acupuncture and Oriental Medicine for the status
of AOM off-site clinics.
EARTHQUAKE RESPONSE PLAN
When an earthquake occurs, drop to the floor and take cover under a sturdy desk or table, or stand
under an interior or exterior door frame. Hold on to the desk or table, as it might be moving. If a desk
or table 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 that could topple
over.
If treating a patient, stop any procedure you are performing immediately, Remove acupuncture needles
or other equipment from the patient. Help the patient to the floor, and get the patient to a safe area
under a table or in an internal doorway. Do not take cover without attempting to assist patients who
cannot help themselves. Once the shaking has stopped, depart the building immediately, via the safest,
closest emergency exit.
If conditions are not hazardous, floor safety wardens will sweep the clinic. Students, staff, and patients
will meet in the safe zone to await instructions from the Medical Director, Facilities Manager or their
designees. On campus, instructions will be provided by the Director of Facilities and Safety or the
Director’s designee.
COMMUNICABLE DISEASE OUTBREAK
These guidelines are for dispensing information to Bastyr University and Bastyr Center for Natural
Health employees and students in the event of a communicable disease outbreak:
o The testing facility should notify the clinic laboratory of a positive test result.
o The Bastyr clinical laboratory notifies the provider of the record and the Medical
Director.
o The Medical Director should notify:
o The clinic and campus personnel via e-mail/voice mail.
o Clinic students via written notices on the bulletin board in the student lounge and via
e-mail.
o The university Health and Safety Office via e-mail.
35

o The student services office.
o The university health and safety office of the student services office notifies students
via written messages on various designated bulletin boards, i.e. the white board and
others.
IMMUNIZATION POLICY
These policies are to protect the health and safety of employees and students who might be exposed to
certain bio-hazardous agents in the campus and clinic working environments.
TUBERCULOSIS SCREENING
Bastyr University and the Bastyr Center for Natural Health mandate annual tuberculosis (TB) tests of
all faculty, staff, and students working in Bastyr University clinics or affiliated clinical areas. TB
screening information/forms for students are part of the Clinic Entry course or clinic orientation.
Faculty and staff are required to provide documentation to the Clinic Safety Officer. The University
Safety Officer or Clinic Safety Coordinator can answer TB screening questions. Students pay $10
towards the cost of their PPD TB test at the clinic. TB screening forms are available at the medical
records desk. The Quanti-FERON test is available at a higher cost.
To review the complete TB screening policy, see TB Procedure.doc in the Clinic Information folder at
\\middleearth.prv\bastyr\campus\data\public\clinic. (see page 3 of this handbook for access details)
Once the required testing is complete, it is the responsibility of students, staff and faculty to submit a
copy of their documentation to the safety office on campus, or to the TB Results drop box near the
clinic Medical Records window.
HEPATITIS B IMMUNIZATIONS
All students, faculty, and staff who are Category I (those who have daily exposure to blood or body
fluids) and Category II (those who have occasional exposure to blood or body fluids) are required to
either take the Hepatitis B immunization series, provide documentation that they have had such
immunizations, or sign a waiver signifying that they refuse the HBV immunization, along with a
release of liability form.
Bastyr University agrees to pay for 50% of the cost of immunization for students (up to the amount
charged by the King county Health Department). Contact the Facilities Office on campus regarding
reimbursement.
Commencement of the immunization series (or submission of a waiver) and TB screening shall occur
before the first day of work for all faculty and staff, before all students begin their clinical training, and
with the start of fall quarter of each year for entering ND students. Documentation of immunization
must be completed by entering AOM students by the deadline specified during the AOM Clinic Entry
class. For AOM students not taking Clinic Entry during their first term at Bastyr University, all
immunization and TB screening records must be completed before beginning a clinic shift. Hepatitis
immunization questions can be directed to the blood borne pathogen safety officer. Requests for forms
can be addressed to Director of Facilities and Safety, or the Clinic lead/Associate Dean. Anyone who
elects to waive the immunization series has the option to change that election at any time and complete
the immunization series.
For external clinic shifts or preceptor sites that require 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.
36

IV. CONFIDENTIALITY, MEDICAL RECORDS,
AND TREATMENT OF MINORS
CONFIDENTIALITY
As a healthcare facility, the Bastyr Center for Natural Health is a member of the public trust. To
preserve this trust, Bastyr University is committed to the highest standards of confidentiality. Breaches
of these policies can permanently jeopardize any individual’s position at Bastyr. Further, Bastyr
University clinics are in compliance with the Health Insurance Portability and Accountability Act of
1996 (HIPAA), a federal law mandating specific requirements with respect to patient privacy.
CONFIDENTIALITY POLICIES
Clinicians handle personal and sensitive medical information in the course of providing care to patients.
It is the responsibility of all faculty members and student clinicians to conduct themselves in a
professional manner and abide by the clinic’s confidentiality policies. Clinicians who are unclear about
a policy or procedure are to utilize the resources available to them to clarify any misunderstanding they
might have. Moreover, clinicians have a responsibility to intervene or report policy violations or
wrongful disclosures when and if it is known to them. Unprofessional practices reflect poorly on
everyone at the clinic, and in their profession. It can also damage the clinic’s relationship with patients,
and put the institution at legal and financial risk, including substantial penalties under federal law
(HIPAA). Direct all questions related to medical records or confidentiality policies to the Medical
Records Office at (206) 834-4151. Bastyr is dedicated to upholding the professional standards of the
medical community as well as ensuring the safety and well-being of all its patients.
BREACHES OF POLICY
Clinicians who violate clinic confidentiality policies will be subject to disciplinary action. Depending
on the circumstances and severity of the violation, student clinicians can be subject to any or all of the
following: loss of clinic credit, a failure event, or suspension or dismissal from the university.
DE-IDENTIFICATION POLICY
The following de-identification guidelines are to protect patient confidentiality. All notes taken down
by students for self-study and all case summaries submitted for publication in the Bastyr Center for
Natural Health Journal must adhere to these guidelines.
No full-face photographic images or comparable images may be used.
Note: Partial pictures showing unique tattoos or piercings may not be appropriate. When in doubt,
check with the Medical Director regarding the use of images in any publication.
Omit the names of any of the following parties:
o Patient
o Patient’s relatives
o Patient’s employer(s)
o Patient’s household members
o Known close acquaintances*
37

*Names of Bastyr clinicians and faculty involved in treating the patient may be included as long as
none of the above relationships is identified. Contributor consent is required.
All geographic subdivisions smaller than a state level are omitted.
o Stating a patient is from Washington State, for example, is acceptable, but including a
patient’s city, county, precinct, zip code, street address, or equivalent geo-code is
not.
Omit all of the following date elements (except year*):
o Birth date
o Admission date
o Discharge date
o Date of death
*A patient’s age and year of birth may be stated as long as the patient is 89 years of age or younger. If
a patient is 90 or more years of age, the patient’s age or birth year may not be used. For example,
stating “a 95-year-old man coming in for treatment of insomnia” would not be permissible and should
instead be reported as “an elderly man coming in for treatment of insomnia.”
Omit all of the following elements:
o Patient phone numbers
o Patient fax numbers
o E-mail address
o Social security numbers
o Medical records numbers
o Patient account numbers
o Biometric identifiers
o Any other uniquely identifying numbers, characteristics or codes
RECORD HANDLING RESTRICTIONS
Access
Patient medical information is available to clinicians on a ‘need-to-know’ basis. Clinicians may request
patient records from the chartroom as needed to prepare for, document, or provide patient care.
Clinicians may access patient records for compiling chart summaries for grand rounds and teaching
purposes, provided they currently have or have had a treatment relationship with the patient, and the
record is not designated as ‘restricted.’ Clinicians who wish to access other patient records or perform
chart reviews for other purposes must contact the clinic director to secure pre-approval for such access.
Patients must follow clinic policy to access their own medical information and chart.
Use and Return
Return all charts to the appropriate chart return area or chartroom at the end of each business day. This
is necessary to ensure adequate accounting of all patient records. Patient records used on an AOM shift
must be complete, including supervisor charting and signatures, and returned to the Medical Records
area in AOM or the Medical Records office at the end of each shift.
38

Photocopying
Direct copying of any patient medical information, progress notes, or lab work is prohibited. It is not
acceptable to directly photocopy patient medical information and subsequently redact (blacken) the
patient’s name or other unique identifiers. This does not adequately ensure patient privacy and is a
prohibited practice at the clinic. If a clinician wishes to retain patient medical information for
educational purposes or therapeutic research, the medical information contained in any progress notes,
lab work, or chart documents not described above must be transcribed to a separate sheet of paper or
electronic document and include no uniquely identifying elements. (See clinic de-identification policy
for a complete list of uniquely identifying elements.)
Transporting Records
All uniquely identifiable patient information, including patient charts, loose chart notes, administrative
reports, or other documentation in hardcopy or electronically stored format must remain in the building
at all times. The medical records manager, or Medical Director or their designee must authorize any
activities that require transportation or removal of such clinic records from the clinic. Unauthorized
transportation of patient records or removal of patient information from the clinic is a wrongful
disclosure and is strictly prohibited.
Note: If a student clinician removes a chart or chart notes that contain any patient identifying
information from the premises, disciplinary action will result as follows:
For a first offense, student clinicians will receive a failure in clinic for one entire quarter shift,
including loss of credit for clinic shift hours and patient contacts.
For a second offense, clinician will receive a failure event as described above and be subject to
immediate suspension from the institution.
Secure Vs. Non-Secure Areas
Uniquely identifiable patient information, as described above, must not be left in non-secure zones of
the clinic. Non-secure, public zones include all hallways not designated as ‘staff only’ areas, waiting
rooms, classrooms, conference rooms, treatment rooms, lounges and break rooms, libraries, restrooms,
main dispensary shopping areas, stairwells, elevators, or any other area not expressly designated as a
secure zone. Designated secure zones include assigned preview-review areas, the clinic laboratory, the
chartroom, and all faculty and administrative offices of authorized personnel. Please note that while
preview-review discussions occasionally occur in classrooms and conference rooms, these areas are
not designated preview-review areas or secure zones. Patient records must never be left unattended in
unsecured classrooms or conference rooms. All identifiable patient information must be removed from
preview/review rooms at the end of each daily shift.
Disposal
All notes and documents that are no longer needed and containing unique patient identifiers, as
outlined in the de-identification policy, are shredded after use or placed in a secure, blue, shred only
bin. Placing such documents in trash or recycle bins is a wrongful disclosure of patient information and
is prohibited.
Wrongful Disclosures
All clinicians are required to report any known wrongful disclosures to the medical records manager.
Wrongful disclosures include any uniquely identifiable patient information that has been lost, stolen,
wrongfully made public, or improperly handled.
39

Patient Access
Clinicians may not give patients unsupervised access to their charts at any time. Leaving charts
unattended in the treatment room with patients jeopardizes the integrity of the record, because patients
may alter or remove parts of the clinic’s official treatment documentation. Similarly, clinicians may
not bring one patient’s chart into the treatment room while treating another patient. If patients wish to
view their records, please have them contact the medical records manager or medical records
coordinator to schedule an appointment to view them.
COMMUNICATION RESTRICTIONS
Preview-Review Sessions
Patient information is discussed only in preview-review sessions in a manner that omits uniquely
identifying information. Discussions should be limited to the patient’s age, gender, and medically
relevant information necessary for learning and conducive to the advancement of clinic competency.
Clinicians may refer to patients using the initials of the first and last names for clarification in
discussion. It is not appropriate, however, to use a patient’s name, date of birth, or personal account
information in preview-review discussions. Moreover, discussions may not include names of relatives
or known acquaintances, specific occupational information, or any other uniquely identifying acts. (See
clinic de-identification policy for complete list of uniquely identifying elements.)
Records designated (i.e. labeled) as ‘restricted’ may not be discussed in preview-review sessions. Restricted
records include records of students, staff, faculty, and their immediate relatives. Such records are only
discussed among the clinicians directly involved in the patient’s care. Similarly, restricted records may
not be used for grand rounds summaries or discussed among clinicians not directly involved in the
restricted patient’s care – even if this discussion does not include uniquely identifying elements.
Faculty may opt to restrict access to an individual’s chart by notifying the medical records manager.
The medical records office will make the necessary changes and grant the chart ‘restricted’ status. A
student clinician may not grant a record restricted status.
Public vs. Private Areas
Patient cases may only be discussed freely in private areas. Treatment rooms, private offices,
designated preview-review areas, or closed classrooms and conference rooms are sufficiently private to
allow free discussion of patient information. It is inappropriate to discuss patient cases in hallways,
waiting rooms, or other public, non-secure areas using any uniquely identifying information.
Clinicians must never discuss medical treatment with a patient in a public area at the clinic, even if the
patient consents to such discussion. Not only could such a discussion result in a misunderstanding
about what was acceptable subject matter, but could also present a poor image to other patients.
Discussion of patient cases outside the clinic must be done in a manner that excludes all uniquely
identifying elements. Students are to refrain from discussing other student cases outside the clinic
entirely – even in a de-identified fashion.
Minimum Necessary Standard
Clinicians are required to abide by a ‘minimum necessary standard’ when discussing patient
information with other clinicians not involved in the patient’s health care or when discussing such
information with staff members of various departments. Clinicians may only discuss patient
information to the extent necessary to accomplish the task at hand. It is inappropriate to discuss patient
medical information with staff or faculty not directly involved in a patient’s health care, if disclosing
such information is not necessary in order for that staff or faculty member to perform his or her
40

essential work duties. Clinicians shall use their professional judgment in determining what information
is necessary and appropriate to communicate.
Releasing Information
Clinicians are prohibited from releasing patient information, with the exception of releasing
information to a patient, the patient’s legal representative, or another health care provider involved in
the patient’s care, when the release is either verbal (in person or over the phone) or in the form of a
summary/referral letter (i.e., does not involve copying chart notes). The medical records office must
process all other releases including faxes. All other inquiries for patient information are made by
contacting the medical records helpline at (206) 834-4151. If a clinician wishes to enclose chart notes
along with a summary/referral letter, the medical records office must provide the enclosure and mail
the letter on the clinician’s behalf. All questions concerning representative authority are directed to the
medical records office. (See Medical Records section below for more information on records releases.)
Faxing of patient information
Clinicians who need summary and referral letters faxed to other health care providers and a copy of the
correspondence placed in the chart, should request this of medical records Students must first call and
verify all fax numbers with the receiving party prior to faxing. Clinicians are not to fax copies of chart
notes, such as labs, progress notes, or other uniquely identifiable information to any third party,
including other health care providers. All such releases must go through the medical records office. All
incoming faxes containing patient medical information must go to the medical records office at (206)
834-4131. Incoming faxes containing any patient information should NOT be directed to the any other
clinic fax number.
E-mailing patient information
Clinicians are prohibited from e-mailing patient information unless the communication is with an
authorized clinician or staff member, and the e-mail correspondence is neither directed to, nor
originates from, an external server. For example, a clinician may use an assigned faculty or student e-
mail account (@bastyr.edu) to e-mail patient information to another authorized staff member or
clinician within the organization (@bastyr.edu). E-mailing patient information from or to an e-mail
account at external servers, however, such as Hotmail©, Yahoo©, America Online©, etc., is prohibited
and constitutes a wrongful disclosure.
In addition, when a clinician or authorized staff use e-mail for patient follow up (e.g. Supervisor e-
mails student that patient’s labs are in, please call patient with these directions) they must ensure that
all e-mails de-identify patient information.
For example: if Sue Smith was seen in the first hour in room three of Dr. Robert’s Thursday afternoon
shift, the e-mail could state: Labs are in for JS, first hour patient on your Thursday 2.0 shift from
March 5 th . Please call her and ask her to make a follow up appointment to review the labs and set up a
treatment plan. Please document the phone call and forward the chart to me to sign.
Please Note: this internal email communication is not part of the medical record and should not go into
the chart.
Student clinicians may not correspond with patients via e-mail and must direct any such
communications to their faculty supervisor upon receipt.
41

MEDICAL RECORDS
The medical records department includes file clerks and office staff who are responsible for chartroom
workflow and health information management at the clinic. This includes all records at Bastyr Center
for Natural Health. Key contact information is below:
Medical Records & Billing Manager 206-834-4164
(questions concerning clinic policies, departmental management, and staffing)
HIPPA Compliance Officer 206-850-2955
(questions concerning legal matters, medical record policies, and safety)
Medical Records Helpline 206-834-4151
(questions regarding general medical records services)
Medical Records Fax Number 206-834-4131
Medical Records Fax Number 206-834-4131
(all non-billing* related faxes that contain patient information)
Billing Office Fax Number 206-834-4136
(*billing faxes, including referrals, credentialing, and corrected claims issues)
The medical records department is dedicated to accounting for all medical records. If you suspect that
a patient’s medical record might be missing, report it to the medical records office immediately.
SERVICES AND SCOPE OF THE MEDICAL RECORDS DEPARTMENT
The medical records office handles all requests for medical records releases from the clinic to third
parties. The medical records department is also responsible for:
o General chart maintenance and standardization.
o Storage, transportation, and ultimate destruction of the physical patient record.
o Answering questions about proper charting procedures, confidentiality issues, or the
release of medical information from the clinic.
Clinicians are not to release or loan medical records to any third parties, including the patient. Direct
patient requests to the medical records office for processing. (See section on release of records and the
section on confidentiality policies for more details.)
The medical records office serves all faculty members, student clinicians, and patients. Clinicians who
have special requests or circumstances are welcome to call (extension 4151) or visit the department.
The medical records office will:
o Bring records to clinicians that are currently seeing a patient.
o Contact clinicians with follow-up information as requested.
o Assist clinicians in determining current addresses and phone numbers for other health
care providers.
o Help clinicians avoid many common mistakes in directing correspondence to large
facilities.
42

o Mail or fax any correspondence (including referral letters, summary letters, and
physician statements) on behalf of clinicians, and/or make a copy of the
correspondence for the chart upon request.
ACTIVE RECORDS AND CHART STORAGE
Medical records for patients who have visited the clinic within the last 18 months are ‘active’ records
and are stored on site in the chartroom located on the second floor. Older, ‘inactive’ records are stored
at an off-site storage facility. When a patient schedules an appointment, inactive charts are retrieved
from storage and reactivated. However, if a clinician needs a chart from archives for other purposes,
such as an Institutional Review Board (IRB) approved chart review, clinicians must submit their
request for the record to the medical records office using the Record Request slip. See below.
REQUESTING PATIENT RECORDS FROM THE CHARTROOM
Patient charts pulled and prepped for upcoming scheduled appointments are placed in the designated
room slots for their corresponding shift 24 hours in advance of the patient’s appointment. There are
occasions that warrant a clinician to request a chart outside of scheduled appointment times. Clinicians
will often need to request charts to complete charting for appointments, make calls to patients, review
outside medical records, or prepare for an upcoming appointment.
To request a patient’s record from the second floor chartroom, clinicians must complete a Record
Request slip and submit it to the proper slot in the chartroom. All request slips must include the
patient’s first name, at least the first three letters of the patient’s last name, the date of birth OR the
patient’s ID#, the date of request, and the name of the individual requesting the chart. Illegible or
incomplete Record Request slips are not processed. Therefore, these slips must be written legibly and
include all required information.
The Record Request slip shown below is to request charts from the chartroom. Terms of checkout and
instructions for using the slip are on the back of the form.
Record Request
Patient Information:
Date: _______________
First Name: ___________________________ Last Name: ______________________
(minimum of first 3 letters of last name required)
DOB: _____________ ID#: _____________ Type: (see back) ________________________________
(not needed if requesting most recent volume of record)
BASTYR VIS MEDICATRIX NATURAE
Out to: ___________________
(Please write legibly to avoid unnecessary delays in processing your request.)
43

Faculty providers frequently receive Patient Chart Requires Action (PCRA) slips from student
clinicians, medical records staff, and patient services representatives. These slips indicate specific
actions that must be taken regarding a patient’s record. These actions can include providing missing
signatures and chart entries or following up on patient callbacks and reviewing outside medical records.
A PCRA slip also serves as a record request slip for a patient's chart, in lieu of the actual Record
Request slip. Please note that some patients have multiple volume charts. Unless otherwise indicated,
clinicians receive the patient’s most recent chart volume. A request for multiple chart volumes for a
patient must accompany a Record Request slip or PCRA slip for each volume requested. CHM
students may request up to six charts from the chartroom at one time. All other student clinicians may
request up to three charts at a time. Please note that requests can take up to 20 minutes to process, and
all charts must be returned to the chartroom by the end of the day. Student clinicians are NOT to
remove patient records from the building. Removing patient records from the clinic will result in
disciplinary action. (See page 39, transporting records section.)
PCRA Slip: The Patient Chart Requires Action slip requests that supervisors complete a special
follow-up. When submitted, this form can serve as a chart request in lieu of a Records Request Slip.
Patient Chart Requires Action
To: ______________________________
Patient’s Name:
_________________________________
Patient’s DOB: _______________
(Required)
From: ___________________________
What is needed:
Today’s
Date:
_______________________
Your signature on visit notes
Your entry in patient visit summary
Your signature on phone contact notes
Your review of outside medical records
Other: __________________________________________
(date of visit): _________________
(date of visit): _________________
(date of contact): ______________
(date received): _______________
RECIPIENT, SIGN & DATE HERE TO REQUEST THIS
CHART:
_________________________________________________
DATE: ______________
44

REQUESTING A PATIENT’S RECORDS FROM ANOTHER PROVIDER
If clinicians would like to receive a patient’s medical records from another healthcare facility or
practitioner, they must have the patient complete an Authorization to Release Confidential Health
Information form. Clinicians should verify that the patient has filled the form out completely*, make a
copy for the chart and the patient, and submit the original completed form to the Medical Records
mailbox marked ‘Requests and Signature Returns’ (located diagonal to the chartroom window on the
second floor). A sample completed authorization form is posted across from the Medical Records
mailboxes for reference.
*When reviewing authorization forms for completeness, clinicians should verify that the patient signed
AND dated the form, and information is clearly written on the form. These elements are frequently
overlooked and cause unnecessary delays in processing. It is not necessary to provide a complete
address for major facilities and providers, if the facility’s full name and location, or the provider’s full
name and location of practice are indicated. Medical Records keeps addresses on file and provides this
information as needed. Clinicians must ensure, however, that the information provided is sufficient to
identify the individual or institution involved. The Medical Records office logs all requests for records,
so clinicians may follow up on a previously submitted request at any time by checking with the
Medical Records office.
Procedure Summary
Have the patient fill out an Authorization to Release Confidential Health Information form.
Check the form for completeness and accuracy. Incomplete forms result in processing delays.
Make two copies of the authorization form, one to be given to the patient, the other to be filed in the
patient’s chart (in the back on the right).
Submit the original form to the Medical Records mailbox marked “Requests and Signature Returns.”
Note: Average turn-around-time for receiving records is two weeks. Faculty supervisors receive notice
when the records arrive.
Expediting Requests
Medical Records will try to accommodate urgent or special requests for records as needed. If Medical
Records has submitted a request for records to another individual or facility, the staff will try to obtain
the records in time for the patient appointment. Faculty may call a facility to follow up on a request,
but records must come through the medical records office when they arrive. Incoming faxes containing
patient information go to (206) 834-4131 in Medical Records.
Similarly, a request may be given priority status by writing ‘RUSH’ at the top of the authorization
form upon initial submission to the medical records office. This option is only for times when normal
processing substantially compromises patient care.
RELEASING RECORDS TO PATIENTS AND OTHER THIRD-PARTIES
Medical Records must process all records releases. If a faculty or clinician receives a request for
records from an outside third party, the faculty member must direct the request to Medical Records for
processing. If patients wish to receive copies of their own medical records, a faculty member must
approve the release, which can result in a delay in processing the request. Clinicians should either
direct patients to the second floor appointment desk or initiate the request process as follows:
Have the patient complete an Authorization to Release Confidential Health Information form.
45

Check the form for completeness.
Have the faculty member initial the form in the top right space next to their printed name, signifying
their approval of the release in advance. (This is an optional step initially, although it expedites the
process. Supervisors may either approve the release in advance by initialing the form in the top right,
or wait to approve it later. Medical Records will subsequently forward the request to the faculty
supervisor, so the faculty member can review and initial it at that time.) There might be a charge for
patients wanting records for personal use. A patient may inquire about fees for records at the second
floor appointment desk. There is always a charge to send patient information to parties not directly
involved in patient care.
Submit the original completed form to the Medical Records mailbox labeled “Requests and Signature
Returns,” located near the chartroom window on the second floor.
Processing of all record releases is performed by the medical records office. Providers are not to
release records directly to patients, because this compromises the clinic’s efforts to maintain quality
control and comply with applicable state and federal health information management laws. The clinic
will not re-disclose medical information from other health care facilities directly to patients except
under extraordinary circumstances. Patients are to contact the original facility to obtain copies of such
information.
As a professional courtesy, copies sent to other clinic/health care practitioners are sent at no charge. A
patient who wants information for personal use may receive up to 10 pages at no charge. Copies in
excess of 10 pages are charged the regular rate. There is no charge for patients who hand-deliver
records to another health care provider, after confirmation of the patient’s appointment with the other
provider. All copies sent to parties not directly involved in patient care are charged the full rate.
Record releases to patients can take up to two weeks to process.
LOOSE CHARTING
Sometimes a chart is not available at the time of an appointment. In this case, the progress notes from
the patient’s visit should be submitted to “loose charting.” Loose charting goes in the Labs and Loose
Charting box, located in the hallway by the second floor copier outside the chartroom door. Loose
charting on the first floor goes in the loose charting tray near the chart shelf.
X-RAYS AND OTHER RADIOGRAPHIC IMAGING
Active x-rays and other radiographic images are stored in the physical medicine department
supervisor’s office for convenience and easy access for up to 30 days. After that time, medical records
staff either returns the images to the facility that has loaned the records to the clinic, or forwards them
to archives for long-term storage, if the clinic owns the record. Faculty supervisors will receive notice
from the medical records office when x-rays and or other radiographic images arrive.
46

DECEASED PATIENTS
Initial Notification
Clinicians, as well as all other staff members, must notify the medical records office if they receive
notice that a patient is deceased. They should be prepared to provide the following information:
Actions Taken
o Identifying who provided notification that the patient was deceased.
o Who at Bastyr received the original notification.
o When the reporting party received notification.
Once notified, the medical records office will:
Provider Follow-Up
o Notify the patient’s primary care provider, if s/he did not provide notification.
o Notify the patient services representatives.
o Place a notice in the patient’s chart that s/he is deceased.
o Flag the patient’s Millbrook account for deceased status.
Upon notification, the primary care provider may choose to contact surviving family members, send a
card, attend the service, or take other actions as the provider deems appropriate. The provider will
inform students and other providers at his/her discretion.
PATIENT FORMS
Patient forms are located in the south corner of the building on each floor. On the first floor, they are in
the AOM storage area. On the second floor, they are on the south side of the preview/review rooms.
Please contact the Medical Records Department or HIPAA Compliance Officer for questions regarding
these forms.
TREATMENT OF MINORS
POLICY AND PROCEDURES ON PROVIDING HEALTH SERVICES
These policies and procedures establish efficient and consistent mechanisms for the care and treatment
of minors at Bastyr Center for Natural Health and privacy-related issues involving a minor's health
records. Any person under the age of eighteen (18) is considered a minor at the Bastyr Center for
Natural Health.
MINORS PROVIDING THEIR OWN CONSENT
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.
47

Exceptions
Below is a list of the exceptions that stipulate when persons under the age of 18 may consent to their
own medical treatment:
Age. A minor's consent is valid if the minor is over the age of eighteen (18). RCW 26.28.015.
Emancipation. A minor's consent is valid for an emancipated minor. RCW 13.64.060. In Washington,
evidence of a minor’s emancipation is through:
o A Judicial Determination. The minor must submit a court order evidencing minor's
Emancipation; or
o A Clinical Determination. The healthcare provider considers that the 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 Wn.2d 16, 431 P.2d 719 (1967).
o Marriage. A minor's consent is valid if the minor is married to a spouse 18 years or
older. RCW 26.28.020. A minor married to a minor may give consent if emancipated
(see “emancipation” 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 when it is
impossible to obtain the consent of the minor, the parent, or the legal guardian. RCW 18.71.220.
Minor with Sexually Transmitted Disease (STD). A minor 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.
Gynecological Services. Provided she is capable of giving informed consent, an unmarried minor 14
years or older may consent to gynecological care, including examination and prescriptions for birth
control.
Reproductive Services. Provided she is capable of giving informed consent, an unmarried minor of
any age may consent to treatment involving the reproductive autonomy of the minor.
Minor Seeking Drug or Alcohol Abuse Outpatient Treatment. A minor 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.
Mental Health Testing and Treatment. A minor 13 years or older may consent to inpatient and
outpatient mental health treatment. RCW 71.34.030 and RCW 71.34.042.
AUTHORIZATION TO CONSENT ON BEHALF OF A MINOR
Any of the following individuals may consent to a minor’s medical treatment:
o Either one of the parents, mother or father, of the minor patient.
o A divorced parent with legal custody.
o 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.
o A minor parent that is married to a spouse 18 years or older. If the minor parent is
married to a minor (dual minor parents), valid consent is determined by the
emancipation factors above.
48

How Consent is Given
o Legal guardian. A signed copy of the court order establishing guardianship must be
filed with the minor's medical records. RCW 26.09.310.
o Authorized department of social and health services (DSHS) representative. A court
order establishing the minor as custody of DSHS and an authorized DSHS
representative may consent to medical treatment for the minor. A copy of the court
order must be filed with the minor's medical record.
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. Please refer
to the clinic’s informed consent policy for additional requirements. If an authorized individual is
unavailable and delegates authority to consent on behalf of a minor to another individual (e.g., a
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 signed
and dated by the authorized individual should state:
“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. If I am personally unable or unavailable to provide
such consent, I hereby authorize [name of designee] to consent to [name of child]'s medical treatment
at the Bastyr Center for Natural Health.”
A required written consent form or delegation statement may be waived in emergency situations or at
the discretion of the clinic director.
ACCESS TO A MINOR’S MEDICAL RECORDS
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 (RCW 70.02.130). The clinic treats requests for disclosure from anyone other than the minor
like any other request for patient information from someone other than the patient.
Parent/Legal Guardian Control 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.
If a minor, authorized to consent for his or her own medical treatment, is a dependent for insurance
purposes, the clinic may submit information to the insurance company for reimbursement in the
ordinary course. Additionally, the clinic should submit all necessary and customary information to
obtain payment for services rendered, even if the services were for a minor under an exception listed
above.
Disclosure Under Insurance Policy
Submission of Health Information by Provider. Providers submit all necessary and required health
information for processing claims with health plans and insurers.
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
49

GRIEVANCE/COMPLAINT POLICIY
V. MISCELLANEOUS CLINIC POLICIES:
GRIEVANCE, PARKING, FUNDRAISING
GRIEVANCE POLICIES - STUDENT
This policy enables students, to voice their concerns about policies, procedures, or other matters, and
have their concerns addressed fairly.
If students have a concern about an occurrence while on a patient care shift, a clinic assistant rotation,
an external clinic shift, or preceptor shift, they should first discuss the matter in private with the
supervising clinical faculty member. If it is not resolved, then students must meet with the Associate
Dean, or their designee, by first submitting a letter outlining the situation, then scheduling a meeting to
discuss the letter’s contents.
If students have a concern about a policy or procedures or clinic operations in general, they should
email a letter to the appropriate Associate Clinical Dean or lead and schedule an appointment to
discuss it with them. If still unresolved, students should forward their letter with an explanation from
the Associate Clinical Dean or clinic lead and schedule a meeting with the Medical Director.
Student concerns about hours, number of shifts, credits, registration, clinic grades, or attendance
should be discussed with the clinic registration staff on campus.
Student concerns regarding the preceptor program are addressed to the preceptor coordinator in each
respective school.
GRIEVANCE POLICIES - PATIENTS
If patients have a grievance, the attending supervisor or the student clinician provides a clinic comment
form for them to complete. The forms are clearly labeled and on display in the patient waiting area. If
the comment is business-related, the completed form is routed to the practice management manager. If
the comment is related to health care services, it is routed to the clinic director and the Associate Dean
or clinic lead for the program in which the complaint related contact and procedure occurred. One of
these two individuals or their designee addresses the matter. Once the concern is addressed, the patient
is notified in writing.
The patient services department and the front desk staff also handle many minor patient grievances.
Upon a patient’s first visit to Bastyr Center for Natural Health, the patient services department gives
the patient a patient information handout. On this handout is a list of patient rights and responsibilities.
Therefore, patients are informed in writing of their right to bring forth any grievance that might arise
regarding their care, service, health plan, or provider network.
Please refer to the Student Handbook for other information regarding grievances, sanction, and appeals
policies.
50

FACILITIES, EQUIPMENT AND PARKING
COPY MACHINE USAGE
The copy machines are for clinic business only. Personal copies, including copies of class notes, must
occur outside of the clinic. Unique codes have been provided for students, staff and faculty to aid in
tracking copy use.
PARKING AND BICYCLES
Students must use on-street parking. The underground parking lot is for patient parking only. Cars will
be towed if this rule is violated. Suggestions for student clinicians include: carpooling, using Metro or
the Bastyr University Shuttle, or bicycling to the clinic if possible. There is a bike rack in the basement
parking area. Do not park bikes against the handrail outside the front door, along the ramp leading to
the front of the clinic, or anywhere along the street where the sidewalk or entrance might be partially
blocked.
TELEPHONE CONTACT POLICY
Please observe the following rules for phone contact:
The clinic’s phones are for clinic business only.
All calls to patients must be pre-approved by the supervising clinical faculty member.
If the patient’s residence is a long distance from the clinic, students must obtain permission from a
supervisor to call and use a clinical faculty office phone.
Calls to/from patients should be limited to three 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.
Clinicians 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. Student clinicians and the supervising
physician/clinical faculty members should both sign the note. Do not offer any new treatment advice or
change any treatment plan without approval from the supervising clinical faculty member.
There is a student phone in the lounge that may be used for local personal calls.
Students should never give their home phone numbers to patients. Any business that a clinician needs
to discuss with a patient should take place at the clinic, in person, or by phone.
PAGERS/CELL PHONE USAGE
All pagers and cell phones must be on vibratory alert mode (silent alert) or turned off while in the
clinic, except preview/review and lounge areas. Furthermore, it is not permissible to answer these calls
in a room with a patient during a patient visit. Answer urgent calls outside of patient care rooms.
51

CLINIC CLOSING TIME
In general, the clinic closes one hour after the last shift has ended. Students are required to leave the
building prior to the last walk around by clinic facilities at the end of each business day. Facilities
personnel will alert people of closing time about 15 minutes ahead of the actual closing. Students need
to finish their work and charts and return them to medical records so that they can be out of the
building by the appropriate time. AOM clinicians must finish all charting on a specific patient chart by
the end of the shift when the patient was seen. There may be exceptions if students are working
directly with a clinic faculty member after hours. In this case, students must be in direct proximity of
the faculty member and must leave when they leave.
Current hours are listed below and can change at any time.
Day Last Shift Ends Closing Time
M, T, Th 9 pm 10 pm
W, F 5 pm 6 pm
Sat 1 pm 2 pm
CULTIVATION AND SOLICITATION POLICY (FUNDRAISING)
All fundraising activities must be coordinated through the Development Department at campus.
All departments, faculty, staff, and students must contact the Development Department before
cultivating or soliciting any prospect or donor for any project or campaign. The Development
Department coordinates all fundraising to ensure that those prospects are cultivated and solicited
appropriately. Without this coordination, donor relations can be damaged if, for instance, more than
one person solicits the same prospect/donor at the same time for different Bastyr projects.
Coordination also ensures that Development can assist any person or department properly with
cultivation and solicitation activities.
DONATIONS
The Development Department creates a file for each gift in our donor database. If someone wants to
make a donation, have him or her simply write out a check to Bastyr University or contact
Development at 425-602-3051. If a donor wants to contribute to a specific department or program
only (and not the Operating Fund), they need to specify which department/program they intend in a
note or letter.
52

IN-KIND DONATIONS
If a company or individual wishes to make an in-kind donation, please follow this procedure before
acceptance:
Gifts-in-Kind (furniture, equipment, securities, real estate, books, etc.) must be reviewed with special
care by the Development and Finance Departments to ensure that acceptance will not involve financial
commitments in excess of budgeted items or other obligations disproportionate to the usefulness of the
gift. Bastyr does not automatically accept all in-kind donations. The University must first determine if
the item(s) is something needed. If so, contact the Development Department at 425-602-3051, and you
will be given an in-kind donation form to fill out and return. The donor’s estimation of the dollar value,
along with what you consider the item(s) dollar value to be, will be needed. When gifts-in-kind are
given to this organization with the donor intent of receiving a tax deduction, it shall be the
responsibility of the donor, not the organization, to obtain an appraisal of the gift. It is in the donor's
best interest that the Bastyr not provide directly, nor be responsible for securing, the services of
appraisers in connection with gifts to the university. Development will send out thank you letters
within 48-hours upon receipt of the item(s) and copy your department.
ACKNOWLEDGEMENT LETTERS
The Development Department sends acknowledgement letters for all donations within 48 hours of
receipt of contribution. The President of Bastyr University or Vice President for Development and/or
other appropriate persons sign the letters.
VOLUNTEER OPPORTUNITIES AND RECRUITMENT
The Development Department identifies specific ways volunteers can be utilized for stewardship and
fund raising. The goals for involvement of volunteers in fund raising efforts are:
o Relationship building.
o Social interaction with other donors, faculty, alumni, staff, and students.
o Prospect identification and development.
o Broadening our network of donors/prospects.
COMMENTS AND FEEDBACK
If you receive a comment or complaint regarding a fundraising event or solicitation, please contact the
Vice president of Development at 425.601.3008.
53

VI. APPENDICES
I. CLINIC CONTRACT
II.
III.
IV.
STUDENT IMMUNIZATION CHECKLIST
STUDENT CLINICIAN ABSENT/SUBSTITUTE FORM
MEDICAL ABBREVIATIONS
V. CO-MANAGEMENT: TEMPLATES AND ETIQUETTE GUIDELINES AND
REFERRAL LETTERS
54

Appendix 1
CLINIC CONTRACT
By signing this document, I am verifying that I have thoroughly read and familiarized myself with the
Student Clinician Handbook, have attended the CE II class or clinic orientation, and received the
information provided therein.
I have especially noted the following areas and their differences 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, 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 global module and department module(s)
for my program(s), including all revisions and updates. I understand I am 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/or clinic time
sheets is cause for denial of all related clinic hours and may lead to additional disciplinary sanctions.
Signature: ___________________________________________ Date: ______________________
Printed Name: ________________________________________Degree Program(s): ____________
A signed copy of this form, given to your instructor, is a requirement to pass the Clinic Entry course(s)
and clinic orientation (OM4800-AOM or NM6804-ND). This signed copy will be on file with the
clinic registration staff, and is a requirement for entering clinic.
55

Appendix 2
Bastyr University Health and Safety Department
STUDENT HEPATITIS B CHECKLIST
It is recommended that health care workers exposed to blood or body fluids be vaccinated against
Hepatitis B. Medical providers and students fall into this risk category both in the Bastyr Clinic and in
some classes. Immunization provides 100% protection of contracting Hepatitis B. Therefore, each
student should consider vaccination. Vaccination for Hepatitis B consists of a series of three injections.
Please check one box below:
I am immunized against Hepatitis B already, or am in the process of receiving the series. Attached
is a copy of my immunization record or positive HB surface antibody test. I completed the Hepatitis B
Vaccine Series on _________________________ (date).
I was Hepatitis B Surface Antibody-positive on ________________________ (date).
I had Hepatitis B on ______________________________________________ (date).
I wish to receive the series of 3 Hepatitis B vaccinations. I have read the information about
Hepatitis B and the Hepatitis B vaccine. I have had the opportunity to ask questions and understand the
benefits and risks of Hepatitis B immunization. I understand I must have three doses of vaccine to
confer optimum immunity, and I may be tested to document my susceptibility to Hepatitis B before
receiving the vaccine. I understand there is no guarantee I will develop immunity to Hepatitis B by
receiving this vaccine. I also understand I may experience an adverse side effect from the vaccine. I
request that it be given to me, or to the person named below, of whom I am parent or guardian.
(1) Given by: ________________________ Lot number ___________________ Date: _______
(2) Given By: ________________________ Lot number ___________________ Date: _______
(3) Given by: ________________________ Lot number ___________________ Date: _______
I understand that due to my occupational exposure to blood and body fluids which are potentially
infectious, I may be thus at risk for contracting Hepatitis B (HBV) infection, which is a serious disease.
However, I decline HBV vaccine at this time. I understand that by declining the vaccine I continue to
be at risk for contracting Hepatitis B. I also understand that I may change my mind and receive the
vaccination at any time.
This does not apply to me in the work that I do.
Printed Name: _____________________________________
Signature: _________________________________________ Date: ___________
Witness: ___________________________________________ Date: ___________
56

Appendix 3
Bastyr Center for Natural Health
STUDENT CLINICIAN ABSENCE / SUBSTITUTE FORM
It is the responsibility of every Student Clinician to inform their assigned Supervisor of any planned
absence from the clinic, and give this form to the Faculty Administrative Assistant.
Please follow the procedures outlined below:
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.
Notify the Supervisor of each shift you plan to miss, and have him/her sign the appropriate space.
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.
Once the form is complete, submit it to the Clinic Faculty Administrative Assistant in S206. The form
is kept on a quarterly basis.
All of these procedures must be followed in advance of the planned absence.
If you are suddenly ill or have a personal emergency, you must call your supervisor and the front desk
at the clinic to page your supervisor as soon as possible.
An unexcused absence will result in an automatic fail for the quarter.
Name of Student (Please Print): _______________________________________________________
Today’s Date: ___________________________
Date of Absence: __________________________
Department (Please Circle):
Acupuncture/Oriental Medicine Dispensary Counseling
Naturopathic Patient Care Homeopathy Nutrition
Physical Medicine
Lab
Shift (Please Circle): Morning Afternoon Evening
Reason for Absence: ______________________________________________________________
Signature of Supervisor: ___________________________________________________________
Name of Substitute (Please Print): ___________________________________________________
Signature of Substitute: ____________________________________________________________
57

Appendix 4
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 Meaning
AAMA
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
American Association of Medical Assistants
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
58
ARMD
AS
sinistra)
ASD
ASHD
Astigm
ATN
AV
AVR
BaE
baso
BBB
BE
bid
BIN, bin
BK
BKA
BM
BMR
BNO
BP
BPH
BUN
bx
C1, C2 to C8
CA, Ca
CAD
CAT, CT
CBC
cc
complaint
cc
CCU
CDC
CDH
CEA
CHD
age-related macular degeneration
aortic stenosis; left ear (auris
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
basal metabolic rate
bladder neck obstruction
blood pressure
benign prostatic hyperplasia
blood urea nitrogen
biopsy
cancer, calcium
coronary artery disease
computerized axial tomography
complete blood count
cardiac catheterization; chief
cubic centimeter
coronary care unit
Centers for Disease Control
congenital dislocation of the hip
carcinoembryonic antigen
coronary heart disease

CHF
congestive heart failure
CI
chlorine
cm
centimeter
CMA
certified medical assistant
CMML
chronic myelomonocytic leukemia
CNS
central nervous system
CO 2
carbon dioxide
COLD
chronic obstructive lung disease
COPD
chronic obstructive pulmonary disease
CP
cerebral palsey
CPD
cephalopelvic disproportion
CPR
cardiopulmonary resuscitation
CS, C-section cesarean section
CSF
cerebrospinal fluid
CT
computed tomography
CTS
carpal tunnel syndrome
CV
cardiovascular
CVA
cerebrovascular accident
CVD
cardiovascular disease
CWP
childbirth without pain
CXR
chest x-ray
cysto
cystoscopy
D
diopter (lens strength)
do
discontinue
/d per day
DandC
dilation and curettage
DDS
Doctor of Dental Surgery
DandE
dilation and evacuation
Derm
dermatology
DI
diabetes insipidus; diagnostic imaging
diff
differential count (white blood cells)
DM
diabetes mellitus
DO
doctor of osteopathy
DOA
dead on arrival
DOB
date of birth
DPT
diphtheria, pertussis, tetanus
59
DRGs
DUB
DVT
dx
EBV
ECG, EKG
ECF
facility
EDC
confinement
EEG
EENT
EMG
ENT
EOM
eosin
ESR
EST
ET
F
FACP
Physicians
FAGS
Surgeons
FBS
FDA
FEF
FEKG
FEV
FH
FHR
FHT
FS
FSH
FTND
FUO
FVC
Fx
diagnostic related groups
dysfunctional uterine bleeding
deep vein thrombosis
diagnosis
Epstein-Barr virus
electrocardiogram
extracellular fluid; extended care
estimated or expected date of
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
Fellow, American College of
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

GB
gallbladder
GC
gonorrhea
GH
growth hormone
GI
gastrointestinal
gm
gram
gr
grain
GTT
glucose tolerance test
Gtt
drops (guttae)
GU
genitourinary
Gyn
gynecology
H
hypodermic; hydrogen
h
hour
HCG
human chronic gonadotropin
HCI
hydrochloric acid
HCO
bicarbonate
HCT, hot hematocrit
HD
hip disarticulation; hemodialysis; hearing
distance; Hodgkin's disease
HDL
high-density lipoprotein
HEENT head, eyes, ears, nose, and throat
Hg
mercury
Hgb, Hb hemoglobin
HIV
human immunodeficiency virus
HMD
hyaline membrane disease
HNP
herniated nucleus pulposus (herniated disk)
HP
hemipelvectomy
hs
at bedtime
HSG
hysterosalpingography
HSV
herpes simplex virus
hypo
hypodermically
IAS
interatrial septum
IBD
inflammatory bowel disease
ICF
intracellular fluid
ICSH
interstitial cell-stimulating hormone
ICU
intensive care unit
IandD
incision and drainage
ID
intradermal
IDDM
Ig
IH
IM
inj
IOL
iop
IPPB
breathing
IQ
IRDS
syndrome
IS
IUD
IV
IVC
cholangiography
IVF
IVP
IVS
K
KD
kg
KS
KUB
l
insulin-dependent diabetes mellitus
immunoglobulin
infectious hepatitis
intramuscular
injection
intraocular lens
intraocular pressure
intermittent positive-pressure
intelligence quotient
infant respiratory distress
intercostal space
intrauterine device
intravenous
inferior vena cava, intravenous
in vitro fertilization
intravenous pyelogram
interventricular septum
potassium
knee disarticulation
kilogram
Kaposi's sarcoma
kidney ureter bladder
liter
L1, L2 to L5 first lumbar vertebra, second
lumbar vertebra through fifth lumbar vertebra
LA
LandA
LAT, lat
LB
LDL
LE
extremity
LH
LLQ
LMP
left atrium
light and accommodation
lateral
large bowel
low-density lipoprotein
lupus erythematosus, lower
luteinizing hormone
left lower quadrant
last menstrual period
60

LP
lumbar puncture
Ortho, ORTH
orthopedics
LPN
Licensed Practical Nurse
OS
left eye (oculus sinister)
LRQ
lower right quadrant
os
mouth; opening; bone
LUQ
left upper quadrant
Oto
otology
LV
left ventricle
OU
both eyes (oculi unitas)
lymphs
lymphocytes
OV
office visit
MCH
mean corpuscular hemoglobin
oz
ounce
MCHC
concentration
MCV
MD
mets
mg
MH
MI
mix. astig
ml
mm
mono
MRI
MS
MSH
MVP
Myop
Na
NPH
NPO
NSAID
O 2
OA
OB
OB-GYN
OCPs
OD
mean corpuscular hemoglobin
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
P
PA
Pap smear
paren
PAT
Path
PBI
PC
PCP
PCV
PD
PE
PET
PGH
pH
PID
PKU
PMN
PMP
PND
PNS
PO
poly
pp
prn
PT
Therapy
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
paroxysmal nocturnal dyspnea
peripheral nervous system
orally
polymorphonuclear neutrophil
postprandial (after meals)
as required
prothrombin time; Physical
od
once a day
PTH
parathyroid hormone
OHS
open heart surgery
PTT
partial thromboplastin time
OR
operating room
PVC
premature ventricular contraction
61

q (spell out)
qam
qd
qh
q2h
qid
qpm
qns
R, rt right
RA
rad
RAI
RBC
RD
REM
RLQ
R.N.
RNA
R/O
ROM
RP
RU
RUQ
RV
Rx
s
every, daily
every morning
every day (quaque die)
every hour
every two hours
four times a day
every night
quantity not sufficient
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
S1, S2 to S5 first sacral vertebra, second sacral vertebra
through fifth sacral vertebra
SA
SC
SCD
SD
seg
SGOT
SGPT
SH
SLE
sinoatrial node
subcutaneous
sudden cardiac death
shoulder disarticulation
polymorphonuclear neutrophil
serum glutamic-oxaloacetic transaminase
serum glutamic-pyruvic transaminase
serum hepatitis
systemic lupus erythematosus
SOB
SOS
sp. gr.
SR
St
staph
stat
STD
strep
subcu, subq
Svc
SVD
T
shortness of breath
if necessary
specific gravity
sedimentation rate
strabismus (esotropia)
staphylococcus
immediately
sexually transmitted disease
streptococcus
subcutaneous
superior vena cava
spontaneous vaginal delivery
temperature
T1, T2 to T12 first thoracic vertebra, second
thoracic vertebra through twelfth thoracic vertebra
T 3
T 4
TAH
T and A
TB
THA
THR
TIA
tid
TKA
TKR
TNM
top
TPN
TPR
respiration
TPUR
TSH
TSS
TUR, TURP
prostate
TX
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
transperineal urethral resection
thyroid-stimulating hormone
toxic shock syndrome
transurethral resection of the
tumor cannot be assessed
62

U (spell out)
units
VHD
ventricular heart disease
UA
urinalysis
VLDL
very-low-density lipoprotein
UC
uterine contractions
VSD
ventricular septal defect
UGI
ULQ
ung
URI
UTI
UV
VA
VC
VD
upper gastrointestinal
upper left quadrant
ointment
upper right quadrant
urinary tract infection
ultraviolet
visual acuity
vital capacity
venereal disease
WBC
blood count
wt
w/v
x
XP
XT
XX
XY
white blood cell (count); white
weight
weight by volume
multiplied by
xeroderma pigmentosa
exotropia
female sex chromosomes
male sex chromosomes
VF
visual field
63

Appendix 5
PATIENT 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-a-specialist letter, and examples of both letters.
The following are elements of professional etiquette:
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 is completed after the second or third visit. This summary letter is
applicable to all referrals from primary care doctors.
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.
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.
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.
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.
64

Today’s date
Doctor Name
Address
RE: patient name DOB: of patient ICD-9: referred ICD-9 diagnosis
Dear Dr. ________,
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. Re-state 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 the relevant and associated secondary diagnoses/complaints.
ROS (significant): List significant past medical history as well as pertinent negatives.
PMHX: List pertinent or significant past medical history
FAM HX: List pertinent or 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, or most recent, 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,
Doctor’s Name & Credentials
Supervising Faculty
Student’s Name
Student Clinician
CC: patient
65

Today’s Date
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 3 rd , 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
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.
PE: bp: 100/64, p: 52; reg., t: 98.3, rr: 16. Heart: rrr, no extra sounds. Thyroid: non-palpable. 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.
66

After a month on this plan, Ms. Doe returned on March 8 th , when she reported some improvement. She
was having a bowel movement every other day and 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
15 th . 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.
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 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, & Credentials
Supervising Faculty
CC: Jane Doe
Student’s Name,
Student Clinician
67

Today’s Date
Doctor Name
Doctor Address
RE: patient name
Scheduled appt. time and date
DOB: patient birth date
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 state t regarding any known drug
allergies)
Impression: List suspected rule-outs, requested evaluations, examinations, and 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 desired).
_____ treatment.
_____ periodic status reports on the patient if she/he remains under your care.
Thank you for agreeing to see _______. For further information, please contact Dr. _ (ND supervisor)
__ at doctor’s phone #. Thank you so much for your help in the care of this patient.
Sincerely,
Doctor’s Name & Credentials
Supervising Faculty
Student’s name
Student Clinician
CC: Patient
68

Dr. GI Specialist
GI Specialist Building
123 1 st Ave.
Seattle, WA 98111
Today’s Date
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 abdominal pain (789.00.
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 3 rd 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 3 rd , 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 formula for
______Days/weeks/months/years. On October 3 rd , 2001, she began taking Iron citrate (200 mg
elemental iron daily). Ms. Doe has no known drug allergies.
69

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 20, 2001. I will have the written report of this CT faxed to you as
well. In regard to evaluation of this patient, please provide:
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 28, 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,
Doctor’s Name
Credentials Supervising Faculty
Student’s Name
Student Clinician
CC: patient
Enclosure: Abdominal ultrasound written report of 2/99; CBC with differential of 9/25/01
70

VII. INDEX
A
absence · 9
planned · 10
sub form · 57
unexcused · 10
accident
patient/visitor · 33
C
case preview/review · 16
clinic contract · 55
communicable disease outbreak · 35
copy machine · 51
D
deceased patients · 47
dress code · 6
violations · 7
E
earthquake response plan · 35
email · 41
ethics · 5
external sites · 9
F
failure · 13, 15
G
grievance, policy for students · 50
H
handwashing · 25
HEP B · 36
I
immunization checklist · 56
interpreter services policy · 22
L
loose charting · 46
M
medical records · 42
Midterm Letter · 15
minors · 47
mission
Bastyr Center for Natural Health · 3
Bastyr University · 3
N
needle policy · 26
P
parking · 51
patient referrals
intraclinic · 24
to outside providers · 24
R
records release · 45
records request from another provider · 45
S
sanctions · 14
scheduling · 7
specialty shifts · 7
scope of practice · 5
sentinel event · 28
superbill instructions · 21
T
TB screening · 36
telephone contact policy · 51
time management · 17
timesheets · 14
71

CLINIC PHONE DIRECTORY
Bastyr Center for Natural Health………………………………………………..…………..206-834-4100
CHM Dispensary……………………….…....………………………..…....…………………...…….4169
Dispensary …….…………………....…………….…………………..…....…………………...…….4114
In-house Lab …….................................................................................................................................5382
PPL Lab…….........................................................................................................................................4113
Business Office Help Line …………………………………………………………………………... 4183
Medical Records Help Line.....………………………….......….……...…................…………...……4151
Medical Questions Line (internal voicemail access only) ...…....……………..………..…………….4668
ND Resident Pager (urgent calls from patients only) …….................................….…….….206-200-7067
Administration:
Jamey Wallace, ND, Clinic Director (Core) .............................................……………….……..….....4141
Judy Colchin, Clinic Administrator & Projects Manager ………………................….………..……..4118
Anita Blair, Clinic Program Supervisor ……...........…...........……………………………………..…4119
Claudia Starkey, Faculty Administrative Assistant ..............................................................................4139
Kathie Golden, ND, Product Review Coordinator …….............….….……………….………….…. 4156
Marci Wedel, Finance & Clinic Senior Accountant ..........……………..….……....4150 or 425-602-3377
Gary Garcia, MD, Director of Graduate and Community Medicine.….............…..........…………….4124
Martha Diehl, Placement/Preceptor Coordinator……………............….…………....………………..4103
Melissa McCarty, ND Off-Site Coordinator.....……………...........….....…………………….………4104
Seth McOmber, Marketing Communications Coordinator... ...........…….....…………..……………..4163
Ginny (Virginia) Norman, Medical Assistant………….………………..................…..……………...4111
Clinic Safety:
Will Wilson, Clinic Safety Officer ………………………………...………………………. 206-617-9455
Sandi Cassidy, Compliance Officer (HIPPA) ………………………………………………………...4164
Daniel Clark, Safety Director ……………………………………………………………….425-602-3064
Debra Brammer, ND, Blood Borne Pathogen Officer (BBP)……………………………….206-422-8763
Clinic Facilities:
Will Wilson, Clinic Facilities Manager.………………..………...................…..…………………….4157
Norm Chambers, Clinic Facilities Technician II …...................…………..………………………….4110
Rosemary Saldaña, Clinic Facilities Technician II.............…………..……………………...……….4130
72

Patient Services:
Martin Imbach, Manager.…..................................................................….…………………………...4142
Medical Records & Billing Office:
Sandi Cassidy, Manager……………………………………….………........…….....….......................4164
Medical Records Helpline………….………………………………………………………………….4151
Robyn Tannous, Insurance A/R Specialist ...........................................................................................4186
Rebecca Million, Collections Specialist ……....................…….....………………..…………………4165
Sharon Ruffin, Billing and A/R Specialist …........................…….…………….…...………………..4126
Helen Jones, Credentialing Coordinator …...................…………………..….……………………….4177
Business Help Line …………………………….….............. …………………………...……………4183
Chinese Herbal Dispensary:
Allen Sayigh, LAc, Dispensary Manager..…........................................................................................4121
Matt Ferguson, Dispensary Coordinator ……………………………………………………………...4169
Dispensary Assistants:
Renata Chung, LAc…..…………..........………………………………………………..……………..4169
Sean Seery, LAc………………….................…………………………………………...…………….4169
Lisa Nicodemus, LAc ....................…….…..…………………………………………………..……..4169
Dispensary:
Ann Busch, Dispensary Manager ………........................………………………………….................4145
Barbara Nims, Dispensary Supervisor..………………………………………………........................5848
Lead Dispensary Assistants:
Michelle Seligman….….................……………………………………………….…………………..5513
Kristin Ishibashi ……….…....................………………………………..………...…..………………5160
Dispensary Assistants:
Jennifer Kemnitz……………….........………………...………………………………………………5130
Haydn Engelke .................................................................................................................. …………...4114
Erika Boynton ………….…....................……………………………………………………………..5137
Gillian Mamacos………..................…………………………………………….....………………….5767
Karl Morrison ……………………………………………………………………………………….5538
73

AOM Clinical Faculty:
Terry Courtney, LAc, Dean Acupuncture and Oriental Medicine (Core)……...............……………..4162
Steve Given, DAOM, LAc, Associate Dean for AOM Clinical Education (Core)...…........................4179
Benjamin (Boonchai) Apichai, LAc (Adjunct)………..……….................…………………………..5704
Sara Bayer, LAc (Adjunct)……………....................……………….………………………………...5210
Qiang Cao, LAc (Core)……………...........…………..……………………………………………….4197
Wei Yi Ding, LAc (Core)…………….........................……………………………………………….5535
James Dowling, LAc (Adjunct)……….............………….…………………………………………...5826
Angela Hughes, LAc, (Adjunct) ….................………………………………………………………..5156
Susan Kaetz, LAc (Adjunct)……….......................…………………………………………………...5211
Chongyun Liu, LAc (Core)……......................……………….……………………………………….4196
Yuan Ming Lu, LAc (Adjunct)……….....................………………………………………………….5567
Kathleen Lumiere, DAOM, LAc (Adjunct)...............……………..……………………......................5104
Rosey (Xin Dong) Ma, LAc (Adjunct)….......................……..……………………………………….5116
Eric Martin, LAc (Adjunct) …………………………….………………………….............................4122
Andrew McIntyre, LAc (Core)…………………..........…..…………………………………………..4125
Kyo (Richard) Mitchell, DAOM, LAc (Core)…................…………………………………………...4176
Hazel Philp, ND, LAc (Adjunct) ..........................................................................................................5103
Shad Reinstein, LAc (Adjunct)………………….....……..…………………………………………...5152
Lee Hullender Rubin, DAOM, LAc (Adjunct) ……………………………………………………….5112
Allen Sayigh, LAc, (Adjunct) ........................................................... ...…............................................4121
Angela Tseng, DAOM, LAc (Core)……..................…………….....………………………………...5214
Ying Wang, LAc (Core)……….................…………...…………………….………………………...4122
Sue Yang-Eng, DAOM, LAc (Core) …….............………....…...……………..…………..…………4192
AOM Residents:
Hong Yu, DAOM, LAc 2 nd year....................................................................... ………...…………….4146
74

ND Clinical Faculty:
Sarah Acosta, ND (Adjunct) .................................................................................................................5218
Paul Anderson, ND (Core).....................................................................................................................5152
Debra Brammer, ND, Associate Clinical Dean for Clinical Education (Core)…….…………………4198
Cristopher Bosted, ND (Adjunct).......................................................................................................... 5169
Ryan Bradley, ND (Core) ..................................................................................................................... 5170
Matt Brignall, ND (Adjunct) …………………..........……..…………………………….……………5141
Kevin Connor, ND (Adjunct)……………......................………………...……..…………................ 4661
Laurie Cullen, ND (Core) ………....................………….………………….………………………... 4159
Tamara Cullen, ND (Adjunct)……................……………………………….……………………….. 5143
Alyssa DiRienzo, ND (Adjunct)…….................…….………………….…………….……………… 5207
Christian Dodge, ND (Core) ….........……...………………………………………..….......................4660
Patrick Donovan, ND (Adjunct) ................................................................................... 5106
Jill Fresonke, ND (Adjunct) ………………..…................……….….…………………...…. ………. 5145
Alicia Gonzalez, ND (Adjunct) ............................................................................................................ 5164
Jane Guiltinan, ND, Dean and Professor, School of Naturopathic Medicine ……...4105 or 425-602-3386
John Hibbs, ND (Core)…………...........………………………………..………….…..…………….. 4158
Eric Jones, ND (Core)…………………..………..............…………………………..………………. 4129
David Kiefer, MD (Adjunct) ................................................................................................................ 4666
Mark Lamden, ND (Adjunct)………....................………..……………….………………...425-823-6163
Richard Mann, ND (Core) ………….............…………………….………….………………………. 4135
Masahiro Takakura, ND, LAc (Core) ....................................................................................425-602-3293
Nancy Mercer, ND (Adjunct) …….......………….……….……………………………….................. 5204
Steve Milkis, ND (Adjunct) ……….......………….…….………….………………………………… 4148
Jana Nalbandian, ND, Chair of Clinical Sciences (Core) …................……….……..……………….. 4170
Dean Neary, ND, Physical Medicine Chair (Core) …..……................….…………………………… 5183
Andrew Parkinson, ND (Core)……….….…...........…………………………………………………. 4123
Hazel Philp, ND, LAc (Adjunct) .......................................................................................................... 5103
Katie Shaff, ND (Adjunct)……….....………...........………..…………………………...…………… 5109
Nancy Welliver, ND (Adjunct) ……..............………………………….…………………..………… 5182
Phoebe Yin, ND (Core) ………………............……………………………………………………… 4153
75

ND Residents:
Jessica Bean, ND 1st year ……..…………...............………..............…………………………… 4168
Amanda Heep, ND, LAc 1st year ……...…..………………..……………………....................... 4108
Miranda Marti, ND, LAc 1st year.......................................................................................................... 4143
Kelly Moyaert, ND 1st year………….............………………………………………………… 4112
Brendan Smith, ND 1st year.....…………….............…….………………………………………… 4172
Bill Walter, ND 1st year ………......................…………………………......……………………….. 4187
Kimberly Sandstrom, ND 2nd year........................................................................................... 4174
Brandy Webb, ND 2nd year ……..................………..…….........………...……...………............. 4128
Nutrition Clinical Faculty:
Kelly Morrow, MS, RD, Clinic Nutrition Coordinator (Core) …...............……...…….…………….. 4133
Doris Piccinin, MS, RD (Core) ............................................................................................................. 5108
Michelle Babb, MS, RD, (Adjunct) ………..............……………………………................................ 5113
Heather King, MS, RD (adjunct) ………..............……………………………....................................5115
Psychology Clinical Faculty:
Eliza Carlson, RD, MS …………………………………………………………………….………… 5705
Christy Hofsess, PhD (Core)................................................................................................................. 5138
Dan Rosen, PhD (Core)...........................................................................................................425-602-3255
Brad Lichtenstein, ND (Core)…......................………………...……..…. .…….………………...…..5198
Aaron Strong, MA …………………………………………………………………………………… 5181
76