Welcome to the Indian Hills Community College Physical Therapist Assistant (PTA) program. The PTA program is seven (7) terms, (21 months) in length. Upon successful completion of this program, an Associate of Applied Science (AAS) Degree will be awarded.
Indian Hills Community College is accredited by the Higher Learning Commission, member of the North Central Association and the State of Iowa, Iowa Department of Education. The Physical Therapist Assistant (PTA) Program is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), 3030 Potomac Avenue, Suite 100, Alexandria, VA 22305-3085, (703) 706-3245, email: firstname.lastname@example.org and website: www.capteonline.org.
The Physical Therapist Assistant program is part of the Health Sciences Division. This division is led by the Dean of Career and Technical Education. The Associate Dean of Health Sciences reports to the Dean, and can also help with any questions you may have. The Physical Therapist Assistant Program is led by a Program Director, who oversees the PTA Instructor and Lab Assistant.
The PTA handbook is to serve as a guide for all students enrolled in the Physical Therapist Assistant program. It is a supplement to the Indian Hills Community College Student Handbook and College Catalog; consequently all policies and regulations from the handbook and catalog are to be observed in addition to those outlined in the following pages.
We welcome you and want you to know we are here to assist you in every way possible. It is a privilege to have each of you in the Physical Therapist Assistant program.
The Physical Therapist Assistant program, as an integral part of the Indian Hills Community College, has the following mission:
The Indian Hills Community College Physical Therapist Assistant Program’s mission, with the central unifying purpose of student learning, is to graduate knowledgeable, competent, self-assured, adaptable and service-oriented individuals who perform interventions under the supervision of physical therapists in an ethical, legal, safe and effective manner.
We believe physical therapy is an art and science that has as its primary focus the health needs of all individuals – needs ranging from states of high-level wellness to states of illness, disability and impending death. Therefore, education in a Physical Therapist Assistant program is based on a specialized body of knowledge and skills related to movement of the human body and focuses upon preparation of a competent specialized paraprofessional.
We believe that learning is an individual and continuous process resulting in behavioral changes which can be measured, that learning is facilitated and affected by motivation, self-discipline and structured experiences and that the role of the instructor is to guide the learner, identify learning needs, and implement the best approaches to meet these needs. We further believe that the Physical Therapist Assistant student is an adult learner and as such is ultimately responsible for their lifelong learning. We believe that the best knowledge base for practice is a combination of general and technical education. This allows the student to develop into an effective practitioner, responsible, culturally-sensitive citizen and more fulfilled mature individual.
The PTA curriculum has been designed to promote your learning and development so that following completion of the Indian Hills Community College Physical Therapist Assistant Program each graduate will be able to:
- Communicate verbally and non-verbally with the patient, the Physical Therapist, health care delivery personnel and others in an effective, appropriate and capable manner.
- Demonstrate sensitivity to individual and cultural differences in all aspects of physical therapy services.
- Exhibit conduct that reflects a commitment to meet or exceed the expectations of members of society receiving health care services and of the profession of physical therapy
- Demonstrate problem solving and judgment skills such that they are able to provide safe, efficient and effective physical therapy interventions under the supervision of a physical therapist.
- Provide effective education to others regarding physical therapy and physical therapy services.
- Demonstrate competence in performing delegated data-collection techniques necessary for performance of patient interventions in a safe, effective, efficient manner.
- Implement the plan of care written for an individual patient such that goals and outcomes are achieved and discharge planning is performed.
- Complete thorough, accurate, logical, concise, timely and legible documentation that follows guidelines and specific documentation formats required by state practice acts, the practice setting and other regulatory agencies.
- Provide services only under the appropriate supervision of a physical therapist.
- Participate in the administration, organizational planning and operation of the physical therapy services
- Demonstrate social responsibility, citizenship, and advocacy, including participation in community and service organizations and activities.
- Participate in career development based on self-assessment, performance appraisals, work setting and special interest.
The PTA curriculum is designed as a progression with increasing complexity of each subsequent course. All PTA core courses must be taken during the designated term.
To view the full program curriculum, please visit the College Catalog & Student Handbook.
Core Course Descriptions
To view the course descriptions, please click on the links below.
- Physical Therapist Assistant
- PTA 109 - PTA Trends
- PTA 111 - PTA Fundamentals
- PTA 118 - Functional Human Anatomy
- PTA 121 - PTA Kinesiology
- PTA 191 - PTA Modalities
- PTA 202 - Cardiopulmonary and Integumentary Rehab
- PTA 203 - PTA Therapeutic Exercise
- PTA 216 - PTA Orthopedics
- PTA 248 - PTA Neurology
- PTA 252 - Professional Issues
- PTA 290 - PTA Capstone
- PTA 310 - PTA Clinical I
- PTA 311 - PTA Clinical II
- PTA 410 - PTA Clinical III
- PTA 416 - Clinical Experience IV
Lecture and laboratory sessions will be held on the Indian Hills Community College Ottumwa campus. All classes are scheduled Monday through Thursday usually between the hours of 7:30 am and 5 pm. General education classes may be taken at the Centerville campus or IHCC Service Centers during the day or evening. Open laboratory time is available Monday through Thursday between the hours of 7:15 am and 4:45 pm when IHCC classes are in session as long as the lab is not in use for classroom activities. Off-campus laboratory experiences may include visiting local long term care facilities, aquatics facilities, durable medical equipment providers, or other therapy related experiences.
At Indian Hills Community College the safety and security of our students, faculty and staff is always a priority. Safety and the prevention of accidents are the responsibility of faculty, staff and students. Everyone on campus is encouraged to use all available resources and information, as well as common sense decisions, to help foster a safe environment. Refer to the college catalog, student handbook, and appropriate signage posted throughout the campus for policies and procedures regarding safety on campus. If an accident or injury occurs while on the Indian Hills campus it will be immediately reported to a member of the staff or faculty. Emergency care will be provided on campus until emergency medical services arrive. Potential safety hazards will also be reported to the staff or faculty.
Open laboratory time is available for PTA students to practice learned skills when one of the PTA instructors or lab assistants are on campus. Students must contact one of the instructors or lab assistant to let them know that students will be using the lab for practice. First aid kit and emergency numbers are posted in the laboratory in case an urgent situation arises.
While attending clinical and off-campus laboratory activities health and safety policies and procedures of the facility will be observed. If an accident or injury occurs during a clinical experience the procedure described in the PTA Student Handbook under the heading ‘Clinical Experience Incidents’ will be followed. If an accident or injury occurs during an off-campus laboratory experience, it will immediately be reported to the instructor and the staff at the facility so the appropriate procedures can be followed.
The purpose of clinical experience is to allow the student to apply the knowledge and skills acquired in the classroom to a hands-on patient care situation. The clinical is designed to provide students learning experiences with patients, coordination with other health care providers, utilization of support staff and time management. Each student will be supervised by a licensed physical therapist or physical therapist assistant at a facility affiliated with the PTA Program. Students are expected to abide by the hours and policies of the assigned clinical facility.
Clinical experiences are scheduled as follows:
||One day each week for 10 weeks
||One day each week for 10 weeks
||Five days a week for 4 weeks
|Clinical IV A
||Five days a week for 5 weeks
|Clinical IV B
||Five days a week for 5 weeks
Indian Hills Community College maintains professional liability coverage for students in the Health sciences Division. This coverage includes the physical therapist assistant students.
Grading for clinical experiences is outlined in the student clinical manual which students will purchase during the first term.
Clinical education is an essential learning experience and as such the sites are chosen to meet the student’s need for a comprehensive education. The student’s preferences will be considered during assignment of clinical sites, but the final determination rests with the Academic Coordinator of Clinical Education. Clinical affiliations are available within traveling distance of Ottumwa. However, a student may request a clinical site nationwide. A student may be scheduled at a requested site if it provides an appropriate learning experience and is available at the requested time. It is the expectation of the program that students gain clinical experiences in acute care, outpatient and skilled nursing facilities at minimum, with other experiences provided as they are available. Students are required to provide transportation to and from clinical sites. Refer to Appendix B for a list of clinical sites affiliated with Indian Hills.
Clinical affiliations will not be scheduled in physical therapy departments in which the student is currently employed. The student may not be under clinical supervision of a family member or close friend.
Students are not to be substituted for paid staff during any clinical assignments. After demonstrating proficiency, students may be permitted to perform procedures with line of sight supervision.
Students are encouraged to maintain their own personal health care coverage, at their own costs. While clinical education sites will make emergency medical care available to students, the student is responsible for the costs. Students may be required by some clinical facilities to have proof of health insurance prior to beginning a clinical affiliation.
All incidents that are inconsistent with routine care or the patient’s plan of care must be reported to the Clinical Instructor immediately. If a medical emergency occurs, the policies of the facility will be followed. The condition of the involved person(s) will be evaluated and the necessary emergency care will be provided. A written report describing the incident should be completed according to facility policy. In addition the ACCE is to be notified of the incident by the Clinical Instructor and the PTA student. The ACCE will complete the IHCC Safety and Loss Control Accident Report Form and forward this document to the Health Sciences Safety Representative.
Required health care training courses
Students in the Health Sciences Division are required to complete the following courses:
- Dependent adult and child abuse
- HIPAA training
- Bloodborne pathogens training
- CPR: American Heart Association BLS for infant, child and adult
- First Aid: American Heart Association First Aid or Red Cross First Aid accepted
Dependent adult and child abuse, HIPAA training and Bloodborne Pathogens training will be included in PTA 109: PTA Trends taught during the first term of the PTA Program. These courses/modules must be completed in order to fulfill the requirements for PTA 109: PTA Trends. If you believe that you already completed this training, please contact the instructor.
CPR and First Aid are required and must be completed on your own no later than September 30 of Term I. IHCC offers these courses through our continuing education division.
Students are advised to take CPR and First Aid during the summer months prior to Term I of the PTA Program. CPR certification lasts for 2 years. Therefore, students want to make sure that their CPR certification will not expire before graduation.
This information will be uploaded to the student portfolio on the Castlebranch website.
Each student is required to have a physical examination prior to starting the program to assure that the student is physically able to participate in the activities required of a student Physical Therapist Assistant.
Each student will have a physical performed by licensed qualified personnel limited to: physician, physician assistant, or nurse practitioner.
In addition, documentation and/or results of the following immunizations and tests is required: MMR or Rubella Titer; Two-step Mantoux Skin Test for Tuberculosis; Tetanus/Diphtheria Booster; Hepatitis B (optional); and Varicella.
Students who do not have a completed physical will not be allowed to participate in PTA Lab activities or participate in clinical experiences. In addition to the information above, students are also required to have the flu vaccine before attending clinic.
Health Information will be stored in the student portfolio on the Castlebranch Website. The Castlebranch portfolio will contain the following categories of health information:
- Physical exam
- Flu shot
- Chicken pox/Varicella
- Hepatitis B
- TB test
Drug Abuse Policy and Required Drug Screening
All Health Science students will be required to have a drug screen prior to the clinical experience. PTA students will have a drug screen during the first term of the program and during the 6th term of the program. In addition, students may be drug or alcohol tested for reasonable suspicion at their own expense. See policy below. PTA students with positive results on a drug or alcohol test will be withdrawn from the program.
The student portfolio (on the CastleBranch website) will contain the drug screen results. Those results will be available to both the student and program administrator.
The process will be as follows:
- The student will be provided with information on setting up their account for the Castle Branch portal during the mandatory program orientation
- The student will place an order and pay for the drug screen on the portal.
- The student is responsible for the drug testing fee.
- Castle Branch accepts Visa, Mastercard, Discover, debit, electronic check or money order.
- The confirmation of payment will be issued to the student.
- The confirmation form will be printed as proof to the program administrator.
- The program administrator will then issue the Forensic Drug Testing Custody and Control Form.
How should students schedule their drug test?
- Call the Ottumwa Regional Health Center Occupational Health 641-684-2466 to set up a drug testing appointment.
- Take the Forensic Drug Testing Custody and Control Form to the appointment at Ottumwa Regional Health Center Laboratory.
- Results will be submitted to the Castle Branch Certified Background database from the lab testing site.
- The student will receive an email to check their account for further information.
Who gets the results?
- The test result will first be reported to the Medical Review Officer (MRO) associated with Castle Branch for review and interpretation.
- The MRO will then report a confirmed positive test result to the student.
- The MRO will attempt to call the student two times from this phone number 800-526-9341. The hours of the follow up phone call will be between 8-5 EST.
- Any questions regarding the results of any drug or alcohol test may be directed to the MRO.
- Negative Test Result: notice will be posted on the Castle Branch student account of passing the initial drug or alcohol test.
- Positive Test Result/Failed Test: The MRO will confirm any proof of the student prescriptions, and make any necessary updates to the positive test result.
- Right to Secondary Confirmatory Test: A student with a confirmed positive test result may ask for a second confirmatory test using ONLY the results from the first test sample from another approved laboratory within seven days of the IHCC mailing of the positive test results to the student.
- The confirmatory test will be conducted on a portion of the sample collected at the same time as the sample that produced the positive test result.
- The student is responsible for the cost of second confirmatory test.
- The sample of collection test will be split in the presence of the individual student to allow for the confirmatory testing of any initial positive test result.
- During the confirmatory process, students may be suspended from the clinical and/or classroom experience.
Confirmed Positive Results:
- Students with any confirmed positive results will be withdrawn from the program.
Legal Medication/Drugs Notification
- A student must notify the clinical supervisor or program director whenever they are using a prescription or over-the-counter drug, which may affect safety or work-performance.
- In making this determination, the student is responsible for consulting with their licensed healthcare professional and reviewing any warning on the label to determine if any medication or drug would adversely affect the student’s ability to safely perform essential functions of the clinical or classroom experience.
- If the student is deemed by a Medical Doctor, Doctor of Osteopathy, Physician Assistant or Nurse Practitioner to be safe during the clinical or classroom experience, a “release to attend clinical/classroom document” is required to be signed and kept in the student’s file at IHCC.
- The student who does not fully disclose this information will be subject to possible disciplinary action which may lead to dismissal from the program.
Prescription medications that do not impair performance may be brought to the clinical site and should be taken as prescribed. All prescription drugs must be kept in the pharmacy dispensed container.
Testing due to reasonable suspicion:
- Once a student is enrolled in the program, if there is a reasonable suspicion of drug or alcohol use, the Program Director will have the right to approve an additional drug or alcohol test at the student’s expense. The clinical site also has the right to request a drug/alcohol test at the student’s expense.
Reasonable suspicion may include, but is not limited to:
- student behavior or conduct including physical manifestations
- evidence that the involved student has caused or contributed to a clinical or classroom related accident
- objective signs that the involved student may have used drugs or alcohol (i.e., slurred speech, staggering gait, odor of alcohol), or reports from others of a clinical “accident”, slurred speech, etc.
When a program director, faculty member or clinical instructor has suspicion of alcohol or drug use during the clinical experience, the following steps will be taken:
- Remove student from the patient care area or assigned work area and notify the clinical instructor and the Program Director.
- Consult with another faculty, clinical instructor, or employee for verification of suspicions in a confidential manner.
- Upon verification by a second person, inform the student that they are relieved from duty and that there is a need “for cause” drug/alcohol screening.
- If the student admits to alcohol and/or drug use, the student must undergo urine drug testing
- Pending the resolution of any testing, the student will be suspended from clinical and/or classroom sites
- A student subsequently found to have positive test results will be removed from the program.
- All incidents involving “reasonable suspicion” drug testing in the clinical setting will be handled with strict confidentiality
- Costs for “reasonable suspicion” drug testing are the student’s responsibility.
Transportation of student after reasonable suspicion:
- An unimpaired person (such as a family member or friend) or taxi cab must transport the student to nearing testing facility. A release form must be signed by the person transporting the student and provided to the Clinical Supervisor/Program Director. If a taxi is transporting the student, the person observing the student enter the taxi may sign the release form and provide to the Clinical Supervisor/Program Director.
- If the nearest testing facility is at the clinical site, student should be sent for testing and then an unimpaired individual or taxi cab should take the student home. If a taxi is transporting the student, the person observing the student enter the taxi may sign the release form.
- While awaiting transport, the student should not be allowed to leave a supervisor’s presence or ingest any substances.
- If the student insists on driving, either clinic supervisor or Program Director will notify law enforcement.
- Pending the resolution of any testing, the student will be suspended from clinical and field sites.
- A student subsequently found to have positive test results will be removed from the program.
If the student refuses “reasonable suspicion” testing:
- Have an unimpaired individual or taxi take the student home
- Document the following in writing:
- Student behavior
- Actions taken
- Written statement of person verifying behaviors
- Student’s response
- Contact the Clinical Supervisor/Program Director as soon as possible and deliver written documentation to the Clinical Supervisor/Program Director within 3 days of the incident.
- Students who refuse reasonable suspicion testing will be removed from the program.
If a facility other than the approved testing site at Ottumwa Regional Health Center performs drug/alcohol testing:
- The student is obligated to notify the Program Director of any request by a clinical site for additional testing due to reasonable suspicion.
- If tested by a clinical site, the student shall provide the Program Director with a copy of any test results.
- Failure to promptly notify the Program Director shall be ground for dismissal from the program.
- The student is responsible for any expense incurred with testing.
If a student voluntarily discloses a drug or alcohol problem:
- If a student voluntarily discloses that they have an alcohol/drug problem and requests assistance, they are then referred to IHCC Student Health.
- Students may be temporarily suspended from the program and/or clinical experience until such time as they have completed drug/alcohol treatment and are considered safe to return to both the classroom and clinical site by a Medical Doctor, Doctor of Osteopathy, Physician Assistant or Nurse Practitioner.
- Any minor student under the age of 18 must abide by the drug and alcohol testing policy.
- A parent or legal guardian of a student under the age of 18 must sign an acknowledgment of receipt of a copy of this policy.
- Those students who are minors under the age of 18 must obtain notarized parental/legal guardian consent on Section II of the Drug/Alcohol Test Release & Consent For Minors.
- Lack of consent for testing will disqualify the minor from continued clinical participation and participation in the Program.
Providing False Information:
- Any student who provides false information when completing paperwork required for a drug test or when responding to required questions for an alcohol or drug screen test will be removed from the Program.
- Any student who dilutes, contaminates, tampers with, alters or interferes in any way with the collection of a specimen for testing purposes will removed from the program.
- The costs of alcohol or drug rehabilitation, treatment and counseling will be the responsibility of the student.
- Costs of drug/alcohol testing are the responsibility of the student
Criminal and Abuse Background Check Policy
National and State criminal and dependent adult/child abuse checks are required of every student preparing to enroll in an Indian Hills Community College Health Sciences Program. This check must be run PRIOR to the Last day to Drop of the first term of the program, or the student will not be allowed to participate in core class or labs.
The Criminal and Dependent Adult/Child abuse background check procedure is established to meet the requirements for the partnerships between the College and the clinical facilities and/or sites. Students who have a criminal history, and are cleared to participate in an IHCC Health Sciences academic program, are still responsible to work with their professional licensing or certification board for determination if they are eligible to sit for that profession’s licensure or certification. In addition, findings of the Dependent Adult/Child Abuse Background check may make a student ineligible for a clinical affiliation.
Background check will include the following items:
- Residency history
- Social security verification
- 7 year county criminal
- Iowa Child Abuse registry
- Iowa Adult Abuse registry
- Nationwide record indicator and sex offender registry
- Nation-wide healthcare fraud and abuse scan
Students will assume responsibility for the cost of the background check. The background check will be run by Castlebranch and will contained in the student’s portfolio on the Castelbranch website.
Timeline for completion of background check policy:
Check must be run PRIOR to the Last day to Drop of the first term of the program, or the student will not be allowed to participate in core class or labs.
- Students who change from 1 IHCC Health Sciences program to another without a term between may use the first program’s check ONLY if it is no more than 12 months since the initial check was run.
- Students who complete a Health Sciences program and have more than one term before the next program start will need to have the check repeated, no matter how long ago the first check was completed.
Criteria used to determine whether a student is ineligible to participate in an Indian Hills Community College Health Sciences program:
|At Any Time
- Refusal to participate in the background check or evaluation process.
- Iowa DHS record check evaluation determines the student is not eligible to participate in the clinical portion of the course and/or to work in a health care facility.
- A felony conviction.
- A felony, serious misdemeanor or aggravated misdemeanor charge with an outstanding disposition or warrant.
- A serious misdemeanor or aggravated misdemeanor conviction in which the probationary period has not been completed.
- A criminal conviction, of any kind, related to past employment, and/or a healthcare system or organization.
- Inclusion on the child, depend adult and/or sexual abuse registry.
|The Past 5 Years
- A criminal conviction of any kind related to illegal distribution or theft of drugs
|The Past 2 Years
- A serious or aggravated misdemeanor conviction of theft or a pattern of theft convictions
|The Past 1 Year
- A criminal conviction related to the possession of drugs, paraphernalia and/or illegal substances.
|Any of the criteria listed below may disqualify you from enrollment in IHCC’s Health Sciences programs based on factors such as job/program relatedness, patterns, timeframes and/or completion of sentence.
- Recent criminal conviction(s) or charges of any type.
- A misdemeanor conviction involving domestic abuse with injury, violence, or sexual misconduct.
- A pattern of criminal convictions or charges.
- 2 or more OWI convictions.
|*While enrolled in any Health Sciences program at IHCC, it is expected that students report all child abuse, dependent adult abuse, and/or criminal activity, in which they are involved, to IHCC within forty-eight (48) hours of the incident. Failure to do so could result in criminal charges per Iowa Code and removal from the program.
Prospective employers consider attendance records a good indicator of future employee behavior and typically inquire about the attendance records of the student/graduate. The faculty and clinical instructors consider attendance important because learning rarely takes place if a student is absent, regardless of the reason. Therefore, to satisfactorily complete the performance expectations of the physical therapist assistant program, the following policies must be adhered to:
- Students are expected to be present for all clinical experiences. It is expected that students will NOT schedule vacations or other events during clinicals. Students are expected to show up on time and remain at the clinical site for the entire allotted time (ie; you are not allowed to leave early).
- If a student is unable to attend, they are to report the absence each day to both his or her clinical instructor and the ACCE–stating their name and the reason for the absence. The student is required to provide as much advance notice as possible. The student will notify the IHCC PTA instructor at (641) 683-5318 or 1-800-726-2585 ext. 5318. Voice messages regarding an absence may be left 24 hours a day. Notification of absence may also be left via e-mail for the ACCE or through the web services clinical web page. The clinical instructor at the facility should be contacted through whatever means the facility has indicated.
- Clinical attendance will be documented in the student’s record.
- If a student does not report for clinical as scheduled, the clinical instructor and the PTA faculty will counsel the student and provide documentation for the student’s file. Changes in the clinical schedule, including make-up days must be coordinated and approved by the Clinical Coordinator of Clinical Education (CCCE) and /or CI and a PTA faculty member.
- Students will be allowed eight hours of clinical absence during the 21 months of their program.
- Students failing to comply with attendance requirements may be recommended for dismissal from the program.
- A release from a physician will be required to return to clinical following three (3) or more consecutive days of absence due to illness/injury.
- Children may not attend clinical with the parent.
- Before leaving the clinical site each day, the student must report to the clinical instructor.
- Regular and punctual attendance is mandatory in all Physical Therapist Assistant courses. Whether in attendance or not, the student is responsible for all information presented that day both during lecture and laboratory.
- Attendance records will be kept for each course
- Students who must miss a class due to emergency or unforeseen circumstances must contact THE INSTRUCTOR personally by phone or email PRIOR to the start of the class. (1 hour minimum prior to the beginning of class).
- Students will not be allowed to make up any work missed (quizzes, in class assignments, etc) unless prior notification has been made to the instructor.
- To re-schedule any make-up items, the student must initiate the process, and must have contacted the instructor in advance; ie. It is NOT the job of the instructor to track you down and ask you for your homework.
- If there is a quiz – announced or unannounced – during class, the following policy applies: The quiz will be given at the beginning of class and any student late to class will not be able to make up the quiz. Unannounced quizzes cannot be made up. Points will be zero for any missed unannounced quizzes.
- Children may not attend class with parents
- Students must complete a physical before participating in lab portions of class.
PTA Lab Policies
Policy for Practicing in Lab Outside of Regular Class Time
If you would like to use lab equipment (other than sheets, pillows, or bolsters), you must notify one of the instructors or the lab assistant beforehand and get permission. One of the instructors or lab assistant must be in the building at the time in case of emergency. The instructors/lab assistant will use their professional judgment as to whether or not you can be in the lab by yourself or if we need to arrange for an instructor to be in the room.
As the student Physical Therapist Assistant represents the school and the profession of Physical Therapy, it is imperative that certain standards be met and a dress code followed. During class periods, students may use their own judgment in attire, but it must conform to the codes of decency. While in the laboratory, students will be expected to have appropriate lab attire to expose the area being studied. This may include shorts, swimsuit, halter top or sports bra. While at the clinical site, PTA students are required to abide by any dress code required by their specific clinic as well as the following:
Clinical Dress Code:
- Students may be required to wear a white clinical lab coat over their street clothes. This requirement will be determined by the supervisor at the assigned clinical site.
- The student will wear clothing consistent with the clinic’s expectations.
- Clothes will be clean, neatly pressed and free of odor.
- Students will be clean, free of body odor, and have well-trimmed fingernails.
- Hair color and makeup will be conservative in nature. Hair color is to be normally occurring in nature.
- Long hair will be pulled back. Beards and mustaches will be neatly trimmed.
- Jewelry will be kept to a minimum and consistent with the clinic’s expectations.
- Appropriate undergarments will be worn.
- Name tags denoting Student PTA status will be worn.
- Shoes will be practical walking shoes that are closed-toe, have closed back, and a have non-slip soles. Socks must be worn. Athletic shoes may only be worn if approved by the clinical site.
Any student who chooses to disregard the dress code will be verbally warned once and the second infraction will warrant a written warning. A third infraction will result in suspension from the clinical site on that same day until a conference is held with the PTA Program Director or Academic Clinical Coordinator of Education (ACCE).
In a classroom and clinical situation students must conduct themselves in a professional manner. In the clinical setting the Clinical Performance Instrument (CPI) will be used to assess professional conduct and in the classroom the Professional Development Assessment form will be utilized. Please review Appendices A and B in this manual for examples of appropriate professional behavior.
Inappropriate conduct will result in a conference with the course or Clinical Instructor and if deemed necessary the ACCE and/or Program Director. Behavior deemed unprofessional may lead to dismissal from the program.
Policy on Medical Conditions
In the event of the onset of a medical condition while enrolled as a PTA student, the student is advised to discuss the physical demands of the field experience (lifting, bending, carrying, standing on one’s feet, etc) with their family physician in order to assure that participation in the field experience will not be of concern during said condition. If a student is unable to perform certain tasks in class or clinic, a physician’s note is required to excuse the student from the activity. All students must provide a doctors release to return to class and field experiences when they have recovered from their condition. Examples of conditions causing students to be absent for a period of time may include: surgery, extended illness, pregnancy, injury. Students are encouraged to discuss physical conditions with the Program Director.
Leave of Absence Policy
Students wishing to take a leave of absence from the PTA Program must submit a written request to the Program Director. A leave of absence may be granted for emergencies including: hospitalization, birth of a child, or death in the student’s immediate family. A leave of absence may be granted if:
- the student has demonstrated the ability to meet the performance expectations of the program
- the student and faculty are able to develop a curricular plan that assures the student’s progression through the program.
- the student must be able to meet course requirements no later than six (6) weeks following the date the leave of absence is granted, following the Incomplete Grades policy, as described in the College Catalog.
If a student fails one or more core PTA courses during any term of the PTA Program, s/he will be dismissed from the Program, and may re-apply to the program the following year. Students may be re-admitted to the PTA Program following withdrawal or suspension by following the Re-Entry Procedure outlined below:
For students returning one or two years after leaving the Program:
- Re-apply for the Program and meet all current qualifications required of students for the current year
- Follow the PTA Program policies and procedures in place the year of reinstatement
- Contact the Program Director a minimum of one term (12 weeks) prior to the date of anticipated re-entry
- Attend orientation with the Program Director
- Meet with the Program Director as well as other PTA staff in order to review PTA content prior to taking checkoffs and exams. Meetings will be set by the Program Director and will be MANDATORY. Failure to meet with staff during scheduled times will result in denial of re-entry
- Comply with schedule set by Program Director for the student to take selected skills checkoffs as well as comprehensive exams from the core PTA courses that they have already passed. Core PTA courses are defined as: PTA 111: Fundamentals, PTA 118: Functional Anatomy, PTA 191: Modalities, PTA 121: Kinesiology, PTA 202: Cardiopulmonary and Integumentary, PTA 203: Therapeutic Exercise, PTA 216: Orthopedics, PTA 248: Neurology and PTA 290: Capstone. This procedure is in place to ensure that the student has retained their knowledge from previous courses and to help ensure their future success in the Program.
- Pass each comprehensive exam with a minimum 78% for each core PTA course that they have already passed and demonstrate competence on selected skills checkoffs. If the student does not demonstrate competence on the selected skills checkoffs and/or obtain 78% on each of the comprehensive exams, s/he may be required to repeat the course from which the competency or exam was failed. Students will have 2 attempts to pass a checkoff and 2 attempts to pass each of the comprehensive exams.
For students returning 3 or more years after leaving the Program:
- Re-apply for the Program and meet all current qualifications required of students in the Program
- Follow the PTA Program policies and procedures in place the year of reinstatement
- Attend one of the orientations scheduled for incoming students
- Retake all core PTA courses
For all re-entering students:
- Re-entering students will only be admitted if there is space in the current class; ie. If the class is already full, continuing students will be given priority over re-entering students to ensure adequate space in the class
- Students re-admitted to the PTA Program have only one opportunity to reinstate and complete the Program regardless of the reason for leaving the Program. Any subsequent core PTA course failures will result in dismissal from the Program, and the student will not be accepted for re-entry into the Physical Therapist Assistant Program
- For students who have been re-admitted to the Program, subsequent re-admissions for any personal/medical leaves will be considered on an individual basis
The college catalog outlines the policy for acceptance of credit for courses taken at another institution. Decisions regarding transfer of general education courses are made by the registrar. To be considered for transfer credit, the student must have achieved the minimum grade as outlined by the college’s transfer credit policy.
Transfer of courses in the core PTA curriculum will be considered on an individual basis. In order to transfer a PTA course, the student must provide the PTA Program Director with:
- course syllabus
- class schedule
- class outline
- grading criteria
- official transcript that designates that the student took that course and the grade the student obtained in that course.
The Program Director reserves the right to request additional information regarding the course. Decisions regarding the transfer of PTA courses will be made on an individual basis by the Program Director.
Bloodborne Pathogens &HIV Policy
Students may be participating in activities within the Health sciences Programs, which have potential for exposure to infectious diseases including but not limited to Hepatitis B and HIV. Health occupation students must take all necessary precautions to minimize the risk of exposure. Students who fail to comply with the bloodborne pathogen and HIV policy may be asked to withdraw from the PTA program.
In the event of a significant exposure (e.g. an occupational incident involving eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious material, including saliva), the student must report the incident immediately to the instructor or clinical supervisor. The ACCE or Program Director will file a Safety/Loss Report Form describing the incident. The completed form will be submitted to the Executive Dean of Career and Workforce Education.
Follow-up evaluation will be required consistent with Federal regulations. This may involve going to their personal physician or the emergency room. Students are responsible for the cost of their own medical care.
It is highly recommended that all students providing direct patient or child care in the Health sciences Division receive immunization against Hepatitis B. Although this is not required, it is highly recommended and is considered to be an extremely good investment. Students are particularly vulnerable to contamination as their hand washing skills generally are not yet well developed. Although the incidence of the infection is relatively low, the outcome can be fatal. Since there is a vaccine available, all health care providers who are at risk are encouraged to become immunized.
Health care professionals are at increased risk of contracting Hepatitis B infection. Hepatitis B is usually spread by contact with infected blood or blood products and the risk of acquiring Hepatitis B increases with the frequency of blood contact. Hepatitis B virus may also be found in other body fluids, such as urine, tears, semen, vaginal secretions and breast milk. Hepatitis B infection can have severe consequences, including progressive liver damage and the possibility of developing hepatocellular carcinoma. Six to ten percent of the people who contract the virus become chronic carriers.
Vaccination is the only available means of protection against Hepatitis B. No currently available therapy has proven effective in eliminating the infection. This vaccine, prepared from recombinant yeast cultures, is free of association with human blood or blood products. Full immunization requires three doses of the vaccine over a six month period. Because of the long incubation period for Hepatitis B, it is possible for an unrecognized infection to be present at the time the vaccine is given, and in that case, the vaccine would not prevent development of clinical hepatitis.
You will need your physician’s approval or order prior to being immunized. They will provide you with information regarding the contraindications and side effects of the vaccine. Contact your physician for additional information.
As part of the curriculum all students in Health sciences programs will receive instruction regarding Hepatitis B and HIV prior to providing patient care. This instruction shall include but not be limited to:
- method of transmission
- standard blood and body fluid precautions
- types of protective clothing and equipment
- work practices appropriate to the skills they will perform
- location of appropriate clothing and equipment
- how to properly use, handle, and dispose of contaminated articles
- action to be taken in the event of spills or personal exposure
- appropriate confidentiality and reporting requirements
- review of program policy related to refusal to care for specific patients
Post Exposure Procedure for Health Occupation Students
- If a student has been exposed to a contaminant parenterally (needle stick or cut) or superficially through a mucous membrane (eye or mouth) they are to follow the following procedure:
- immediately wash the affected area with the appropriate solution (soap and water, alcohol, water),
- seek appropriate medical attention through their personal physician (students are responsible for their own medical care). This may include baseline testing for HIV antibody at this time, followed by recommended series of testing. (Physicians may also inquire about the students status in regard to tetanus and hepatitis immunization at this time.)
- follow institutional (agency) policy regarding determining HIV and hepatitis status of patient, (students are responsible for the cost of any testing)
- maintain confidentiality of patient,
- seek appropriate counseling regarding risk of infection.
Guidelines for HIV Positive Health Care Providers
- The Center for Disease Control has specific guidelines for health care workers which are revised periodically. They have been incorporated into these policies and are reviewed annually.
- There shall be no routine serological testing or monitoring of students for Hepatitis B or HIV infection.
- Barrier or standard blood and body fluid precautions are to be used routinely for all patients. These include:
- The use of glove(s) when:
- cleaning rectal and genital areas;
- carrying soiled linen;
- bathing patients, if the student has a cut on the hand;
- suctioning or irrigating even if the orifice does not require sterile technique;
- there is, at any time, a possibility of spillage of blood or body fluid onto the student’s hands, (i.e. accucheck, discontinuing an I.V., I.M.s) regardless of the presence of open lesions;
- emptying urine drainage bags, suction catheters, colostomy and ileostomy pouches; and
- providing mouth care.
- The use of masks, goggles or glasses and/or aprons when there is a possibility of fluids splashing onto the face or body and clothing.
Specific Guidelines for Known HIV - Infected Health Occupation Students
- HIV positive health sciences students who do not perform invasive procedures need not be restricted from work/clinical experience unless they have other illnesses or signs and symptoms for which such restrictions would be warranted.
- HIV positive health sciences students should wear gloves for direct contact with mucous membrane or non-intact skin of patients.
- HIV positive health sciences students who have exudative lesions or weeping dermatitis should refrain from direct patient care and from handling patient care equipment and utensils.
- Reasonable accommodations will be made within the curriculum to assist the HIV positive student to meet course/program objectives.
- The policy of agencies utilized for clinical experience will supersede college policy if they are more stringent.
- Confidentiality will be maintained whenever possible, with only the appropriate individual(s) being informed of the HIV status of health sciences students.
Provision of Care
- Assignments are made in the clinical setting to enhance and/or reinforce student learning. It is the expectation that students will provide care for clients to whom they are assigned. In the event that a student refuses to care for an individual the following will occur:
- In consultation with the student the faculty member will determine the reason for the refusal.
- If the reason is determined to be valid the student will be reassigned.
- If the reason is not valid the student will be counseled about unethical conduct and “discriminating against a client regarding but not limited to the following: Age, race, sex, economic status or illness of the patient or client.”
- If it is determined that the reason for refusal to care for specific individual is as noted above, the student will be counseled to consider their future in health care.
- The Dean shall be notified of any such occurrence and may meet with the student along with the faculty member to discuss options, one of which may be withdrawal from the program.
Program Grading Policy
In order to graduate, a student must receive a passing grade in all courses listed for that major and achieve a cumulative grade point average (GPA) of 2.00 or above. This is equivalent to a “C” average.
Minimum satisfactory scholastic achievement is represented by a 2.0 grade point average each term of enrollment. Students who fall below this level will be placed on academic probation for the following term. Students who fail to achieve a 2.0 GPA during their probationary term may then be dismissed from their current program or college. Students not dismissed must have permission from their Dean and from the Registrar to re-enroll for the next term. Very poor work in any term, however, may result in dismissal at the close of that term. Academic probation may affect financial aid. The student is encouraged to see a financial aid counselor for clarification of an individual situation.
Students who are unable to complete assigned work in a course may be given a grade of “I” (incomplete). Students must complete the assigned work as soon as possible (at the discretion of the instructor/ department chair), but no later than six weeks into the following term. Grades for courses left with an “I” past the six-week completion period will automatically convert to “F”.
To successfully complete the PTA Program, a student must achieve a passing grade in all non-core prerequisite courses, and a minimum grade of a “C” in the following courses: BIO 175 Human Anatomy, BIO 176 Human Anatomy Lab, BIO 178 Human Physiology, BIO 179 Human Physiology Lab, and HSC 212 Pathophysiology. If the student is having difficulty with any of the classes, students should first contact the course instructor regarding questions with individual course assignments and grades. Failure to pass the listed biology courses with a “C” will result in the student being in-eligible to continue in the core PTA curriculum sequence. The student will have to withdraw from the PTA program and follow the re-entry policy if they wish to return to the Program. Students may retake HSC 212 Pathophysiology while continuing in the core PTA curriculum sequence but must pass the class with a “C” in order to graduate from the PTA Program.
Students must pass all core PTA courses with a minimum of a “C”, or a 78% to progress in the PTA program sequence. Students who fail to earn a “C” or better in a core PTA course will not be able to continue with the program and will be required to repeat the course at its next offering, typically the following academic year. See the PTA Re-entry policy. Core PTA courses include: PTA109, PTA111, PTA118, PTA310, PTA191, PTA121, PTA202, PTA203, PTA311, PTA216, PTA410, PTA248, PTA252, PTA290, and PTA416.
Exam Grading Policy for PTA Courses
The PTA Program requires a combined average of 78% for exams in the following courses: PTA 111: PTA Fundamentals, PTA 118: Functional Anatomy, PTA 121: PTA Kinesiology, PTA 191: PTA Modalities, PTA 202: PTA Cardiopulmonary and Integumentary, PTA 203: PTA Therapeutic Exercise, PTA 216: PTA Orthopedics and PTA 248: PTA Neurology. The core PTA courses typically have 3 unit exams and one comprehensive final exam.
For example: A student earns 77% on unit exam 1, 76% on unit exam 2, 90% on unit exam 3 and 85% on the comprehensive final. The average for this student would be: (77+76+90+85)/4=82% which would be passing.
A student would be allowed to retake one unit exam to increase their grade. If the student passed the unit exam on the retake, 78% for this exam would be entered in the grade book regardless of the student’s actual score on the retake. The student would have one week from the date that the original exam was returned to the students to complete the retake. There would be no retakes allowed for the final exam in any PTA course. Retakes are required to be taken at the testing center.
For example: A student earns 77% on unit exam 1, 65% on unit exam 2, 90% on unit exam 3 and 85% on the comprehensive final. The student retakes unit exam 2 and passes. The student’s grade of 65% would be replaced by a 78% in the gradebook. The average for these 4 exams would be: (77+78+90+85)/4 = 82.5% which would be passing.
Example of a student failing: A student earns 77% on unit exam 1, 65% on unit exam 2, 65% on unit exam 3 and 70% on the comprehensive final. The student retook unit exam 2 and passed, earning a 78% in the gradebook but cannot retake unit exam 3 since only one retake is allowed. In addition, no retakes are allowed on the comprehensive final. The average for these 4 exams would be: (77%+78%+65%+70%)/4 = 72.5% which would be failing regardless of the points earned on other assignments.
PTA Exit Exam
Each student will take a comprehensive exit exam during PTA290: PTA Capstone during the 7th Term. Students must earn a minimum of 78% on the comprehensive exam prior to graduation. If a student fails to reach 78% on the first attempt of the comprehensive exam, the student will be allowed a total of six attempts to pass the exam.
The student will be given an “incomplete” for the course until 78% is reached. Per Institution policy, an “incomplete” turns into an “F” after 6 weeks. Therefore, the student has 6 weeks to review material and pass the comprehensive exam. The student will not be allowed to take the exam more than one time per week. This gives the student at least one week between exams to remediate. Students requiring a retake will also be required to meet with the Program Director on a weekly basis and complete remediation assignments.
Health Sciences Grading Scale
Health Sciences grading is based upon the following percentage scale:
You may compute your GPA at any time by following this example:
|Functional Human Anatomy
|PTA Clinical I
|Human Physiology Lab
|Credit Hours Attempted: 13
||Total Grade Points: 35
Total Grade Points divided by Credit Hours Attempted (excluding pass/fail) = Grade Point Average (GPA)
(35 / 12 = 2.917 GPA)
Academic Misconduct Policy
To view the full Academic Misconduct Policy, please visit the College Catalog & Student Handbook.
Appeal of Final Grade Policy
To view the full Appeal of Final Grade Policy, please visit the College Catalog & Student Handbook.
Physical Therapist Assistant Appeal of Grade Policy
Students who want to appeal their final grade will follow the policy as outlined in the student handbook and the PTA program policy manual. However, students who have a question regarding the number of points that they received on an individual assignment, quiz or exam, must bring it to the attention of the instructor no later than one week after the graded item is returned. Additional points or grade changes on individual exams, quizzes or assignments WILL NOT be made at the end of the term.
- Written examinations will be given in each core course and laboratory practicals will be given in selected core courses.
- Electronic exams taken outside the classroom will use “Lockdown Browser”. See IHCC student handbook for instructions in use of lockdown browser.
- Each instructor will determine the test schedule and content of the tests.
- Each student must notify the course instructor prior to examination time if they are going to be absent.
- All make-up testing will be done at the IHCC Testing Center located in Trustee Hall.
- The instructor may determine that an alternate format test be given if a student is absent on the scheduled exam day.
- Final examinations will be scheduled for each course
- Written exams follow the 78% policy – see this policy under “Grading.”
Laboratory Practical Exam Policy
Students must pass each PTA Program core course laboratory practical with a 78% or above to pass the course. A student may repeat any component of a laboratory skills practical only once. The instructor will determine which components of the practical are to be repeated. A student who requires a second attempt and successfully passes on the 2nd attempt will receive a 78% in the gradebook regardless of their actual score. Therefore, on a lab practical exam, a second attempt score will not be greater than 78%. Failure to obtain a 78% on the second attempt will result in failure of the course. A student may be asked to remediate as a result of their performance on the lab practical regardless of whether or not the student passed.
Skills Checkoffs Policy
- Skills Check-offs are expected to be completed on or prior to the due date listed for each set of skills. Students must successfully complete all skills check-offs in order to receive a passing grade in the course. These check offs may be done at the end of regularly scheduled labs or during open lab times (as posted).
- Each student is expected to have a “patient” (classmate) with them on which to perform the interventions.
- When skills are completed satisfactorily by the due date on the 1st attempt, the student has the opportunity to obtain 100% of the listed points for that skill.
- If a student needs to repeat a skill competency, the student will only be able to obtain a maximum of 50% of the listed points if it is prior to the due date.
- If a 3rd attempt is necessary, the student may be asked to reschedule the skill check-off after the due date, in order to allow other students a 1st or 2nd attempt. If a student requires a 3rd attempt and/or completes the skill after the due date, it will be worth 0 points.
- However, all students are expected to complete the check-offs regardless of whether or not they obtain points. Students not completing all check-offs for a course will not be permitted to continue in the PTA Program.
- Students are allowed a maximum of 4 attempts to complete a checkoff. See remediation policy below.
Remediation of checkoffs
If a student fails the first attempt at any checkoff, the student must have one of the instructors or lab assistants sign-off/verify that they have practiced the task or reviewed the information prior to taking the checkoff again. The student can do this by practicing with his or her lab partner or with another student. The student will be given a form to use to verify that they practiced the skill. The person the student practiced with will sign off that you have practiced with them. The student will then present that form to the staff member who is doing the checkoff.
Instructors, the Program Director, and the Associate Dean are available for academic counseling. Further counseling is available to students through assigned counselors or by student choice. The physical therapist assistant program faculty have open office hours. Students are welcome anytime. Counseling will always be held confidential and conducted in a professional manner.
Sexual Misconduct Policy
To view the full Sexual Misconduct Policy, please visit the College Catalog & Student Handbook or the college website.
To view the full Non-Discrimination Statement, please visit the College Catalog & Student Handbook or the college website.
Placement services are available to assist students, graduates and alumni in obtaining employment. Contacts with health care facilities are maintained to help individuals find employment. Every reasonable effort is made to assist the student in finding satisfactory job opportunities. Students, graduates and alumni may view job openings on the IHCC web site or the PTA Program Facebook page.
American Physical Therapy Association (APTA)
The APTA is a national organization dedicated to the promotion of physical therapy. Students are encouraged to join the APTA and become active in its functions.
Information concerning the APTA is available in the PTA Program office, by phone at 800-999-APTA or by e-mail www.apta.org. Information regarding the Iowa Physical Therapy Association (IPTA) is available at www.iowaapta.org.
Please refer to your IHCC Student Handbook and IHCC College Catalog for a full listing of college-wide policies and procedures available services.
Communication by Email:
Most communication between IHCC/ the instructors and the student take place via email. It is the responsibility of students to check their IHCC email on a regular basis. For online or hybrid courses, students are advised to check their student email every day.
It is not the health sciences division’s responsibility to take personal messages or telephone calls. If a call for a student is received, the office will search for the student only if the call concerns an emergency.
For a full listing of Faculty members please visit the faculty directory in the College Catalog & Student Handbook or search the Online Faculty/Staff Directory.
IHCC also has a Watts Line, 1-800-726-2585. The extension you desire would be the last four numbers on the regular telephone number.
IHCC is on a Monday-Thursday class schedule with PTA clinical experiences scheduled Monday through Friday.
Occasionally you will encounter circumstances requiring assistance or guidance. The following is a partial list of potential problems and who to see:
||Who to See
|Difficulty/concern with a specific course
|Difficulty with course work in general or problems of a general nature
- Program Director
- Associate Dean
- Dean, Career & Technical Education
- SUCCESS Center
|Concerns about clinical rotations
- Clinical Coordinator
- Program Director
- Associate Dean
- Dean, Career & Technical Education
|Problems/concerns at clinical site
- Clinical Instructor
- Clinical Coordinator
- Program Director
- Associate Dean
- Dean, Career & Technical Education
|Information concerning Policies and Procedures
- Program Director
- Associate Dean
- Dean, Career & Technical Education
- Program Director
- Student Health
- Associate Dean
- Dean, Career & Technical Education
|Concerns about the program
- Program Director
- Associate Dean
- Dean, Career & Technical Education
Feel free to talk to any staff member if you think they can help you.
Definition and Utilization of the Physical Therapist Assistant
The physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a Physical Therapist Assistant Associate Degree Program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).
The physical therapist is directly responsible for the actions of the physical therapist assistant related to patient/client management. The physical therapist assistant may perform selected physical therapy interventions under the direction and at least general supervision of the supervising physical therapist. In general supervision, the physical therapist is not required to be on site for direction and supervision, but must be available at least by telecommunications. The ability of the physical therapist assistant to perform the selected interventions as directed shall be assessed on an ongoing basis by the supervising physical therapist. The physical therapist assistant may modify an intervention in accordance with changes in patient/client status within the scope of the established plan of care.
The physical therapist assistant must work under the direction and at least general supervision of the physical therapist. In all practice settings, the performance of selected interventions by the physical therapist assistant must be consistent with safe and legal physical therapy practice, and shall be predicated on the following factors: complexity and acuity of the patient/client’s needs; proximity and accessibility to the physical therapist; supervision available in the event of emergencies or critical events; and type of setting in which the service is provided.
When supervising the physical therapist assistant in any off site setting, the following requirements must be observed:
- A physical therapist must be accessible by telecommunications to the physical therapist assistant at all times while the physical therapist assistant is treating patients/clients.
- There must be regularly scheduled and documented conferences with the physical therapist assistant regarding patients/clients, the frequency of which is determined by the needs of the patient/client and the needs of the physical therapist assistant.
- In those situations in which a physical therapist assistant is involved in the care of a patient/client, a supervisory visit by the physical therapist will be made:
- Upon the physical therapist assistant’s request for a reexamination, when a change in treatment plan of care is needed, prior to any planned discharge, and in response to a change in the patient/client’s medical status.
- At least once a month, or at a higher frequency when established by the physical therapist, in accordance with the needs of the patient/client.
- A supervisory visit should include:
- An on-site reexamination of the patient/client.
- On-site review of the plan of care with appropriate revision or termination.
- Evaluation of need and recommendation for utilization of outside resources.
Appendix A: Forms for Signature
Appendix B: Clinical Items