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Baig, Karyn Akbaig@selectmedicalcorp.comBevacqua, Christinecbevacqua@kessler-rehab.comBevaqua, Christinecbevaqua@kessler-rehab.comBrady, CaitlinCKBrady@kessler-rehab.comByrne, Aislingaibyrne@kessler-rehab.comCaccavo, Joseph Rjcaccavo@kessler-rehab.comCadby, Jill EJECadby@selectmedicalcorp.comCambria, Lauralcambria@selectmedical.comCambria, LauraLCambria@selectmedicalcorp.comCaputo, Elizabethecaputo@selectmedical.comCarnahan, JanelleJcarnahan@kessler-rehab.comCarolan, TerryTCarolan@kessler-rehab.comCavadini, Nataliencavadini@selectmedicalcorp.comCheung, TammyTaCheung@kessler-rehab.comChun, AlecAChun@kessler-rehab.comCohen, Elyse GECohen@kessler-rehab.comConnelly, KathleenKMConnelly@kessler-rehab.comConnors, AlyssaALLConnors@kessler-rehab.comCording, ChristinaCMCording@kessler-rehab.comCraven, CourtneyCCraven@selectmedical.comCunningham, Kristenkricunningham@kessler-rehab.comDe La Cruz, MelissaMAdelacruz@selectmedical.comD'Elio, JennaJKUHLES@KESSLER-REHAB.COMDeshpande, Aartiadeshpande@kessler-rehab.comAdd New CIDisplaying Clinical instructor 1 - 25 of 126 in totalPrevious 1 2 3 4 5 6 NextSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Clinical Instructors01/23/19 07:26 PMClinical InstructorsWhat criteria do you use to select clinical instructors? (Check all that apply)APTA Clinical Instructor CredentialingCareer ladder opportunityCertification/training courseClinical competenceDelegated in position descriptionDemonstrated strength in clinical teachingNo criteriaOther (not APTA) clinical instructor credentialingTherapist initiative/volunteerYears of experienceOtherHow are clinical instructors trained? (Check all that apply)

1:1 individual training (CCCE:CI)APTA Clinical Instructor Education and CredentialingProgramClinical center inservicesContinuing education by academic programNo trainingOther (not APTA) clinical instructor credentialing programAcademic for-credit courseworkContinuing education by consortiaProfessional continuing education (e.g., chapter, CEUcourse)OtherSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Information About the Physical Therapy Service01/23/19 07:26 PMInformation About the Physical Therapy ServiceNumber of Inpatient Beds For clinical sites with inpatient care, please provide the number of beds available in each of the subcategories listed below: (If this does not applyto your facility, please skip and move to the next table.)Acute care:Psychiatric center:Intensive care:Rehabilitation center:152Step down:Subacute/transitional care unit:Extended care:Other specialty centers:Total Number of Beds:152Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Number of Patients/Clients01/23/19 07:26 PMNumber of Patients/ClientsEstimate the average number of patient/client visits per day:Inpatient0Individual PT:8OutpatientIndividual PT:10Student PT:0Student PT:Individual PTA:Individual PTA:0Student PTA:PT/PTA Team:8Student PTA:PT/PTA Team:10Total patient/client visits per day:Total patient/client visits per day:Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Patient/Client Lifespan and Continuum of Care01/23/19 07:26 PM

Patient/Client Lifespan and Continuum of CareIndicate the frequency of time typically spent with patients/clients in each of the categories:Patient Lifespan0-12 years0%13-21 years1% - 25%22-65 years51% - 75%Over 65 years51% - 75%Continuum of CareCritical care, ICU, acutePlease choose:SNF/ECF/sub-acutePlease choose:Rehabilitation76% - 100%Ambulatory/outpatientPlease choose:Home health/hospicePlease choose:Wellness/fitness/industryPlease choose:Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Patient/Client Diagnoses01/23/19 07:26 PMPatient/Client DiagnosesIndicate the frequency of time typically spent with patients/clients in each of the categories:Musculoskeletal26% - 50%Which Musculoskeletal sub-categories are available to the student:Acute injuryAmputationArthritisBone disease/dysfunctionConnective tissue disease/dysfunctionMuscle disease/dysfunctionMusculoskeletal degenerative diseaseOrthopedic surgeryOtherCerebral vascular accidentChronic painNeuro-muscular51% - 75%Which Neuro-muscular sub-categories are available to the student:Brain injury

Congenital/developmentalNeuromuscular degenerative diseasePeripheral nerve injurySpinal cord injuryVestibular disorderOtherCardiovascular-pulmonary26% - 50%Which Cardiovascular-pulmonary sub-categories are available to the student:Cardiac dysfunction/diseaseFitnessLymphedemaPeripheral vascular dysfunction/diseasePulmonary dysfunction/diseaseOtherOpen woundsScar formationCognitive impairmentGeneral medical conditionsGeneral surgeryOncologic conditionsOrgan transplantWellness/PreventionIntegumentary1% - 25%Which Integumentary sub-categories are available to the student:BurnsOtherOther (May cross a number of diagnostic groups)Please choose:Which other sub-categories are available to the student:OtherSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Staffing01/23/19 07:26 PMStaffingFull-time BudgetedPart-time BudgetedCurrent ion Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Information About the Clinical Education Experience08/16/16 07:18 AMInformation About the Clinical Education ExperienceSpecial Programs/Activities/Learning OpportunitiesPlease check all special programs/activities/learning opportunities available to students.AdministrationAquatic TherapyAthletic Venue CoverageBack SchoolBiomechanics LabCardiac RehabilitationCommunity/Re-entry ActivitiesCritical Care/Intensive CareDepartmental AdministrationEarly InterventionEmployee InterventionEmployee Wellness Program

Group Programs/ClassesHome Health ProgramIndustrial/Ergonomic PTInservice Training/LecturesNeonatal CareNursing Home/ECF/SNFOrthotic/Prosthetic FabricationPain Management ProgramPediatric - Classroom Consultation EmphasisPediatric - Cognitive Impairment EmphasisPediatric - Developmental Program EmphasisPediatric - GeneralPediatric - Musculoskeletal EmphasisPediatric - Neurological EmphasisPrevention/WellnessPulmonary RehabilitationQuality Assurance/CQI/TQMRadiologyResearch ExperienceScreening/PreventionSports Physical TherapySurgery (observation)Team Meetings/RoundsVestibular RehabilitationWomen's Health/OB-GYNWork Hardening/ConditioningWound CareOtherSpecialty ClinicsPlease check all specialty clinics available as student learning experiences.ArthritisBalanceDevelopmentalFeeding clinicHand clinicHemophilia clinicIndustryNeurology clinicOrthopedic clinicPain clinicPreparticipation sportsProsthetic/orthotic clinicScoliosisScreening clinicsSeating/mobility clinicSports medicine clinicWellnessWomen's healthOtherPlease explain:Spasticity clinicHealth and Educational Providers at the Clinical SitePlease check all health care and educational providers at your clinical site students typically observe and/or with whom they interact.AdministratorsAlternative therapiesAthletic trainersAudiologistsDietitiansEnterostomal / wound specialistsExercise physiologistsFitness professionalsHealth information technologistsMassage therapistsNursesOccupational therapistsPhysician assistantsPhysiciansPodiatristsProsthetists / orthotistsPsychologistsRespiratory therapistsSocial workersSpecial education teachersSpeech/language pathologistsStudents from other disciplinesStudents from other physical therapy education programsTherapeutic recreation therapistsVocational rehabilitation counselorsOtherPlease explain:Equipment coordinators.Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Availability of the Clinical Education Experience08/16/16 07:18 AMAvailability of the Clinical Education ExperienceIndicate educational levels at which you accept PT and PTA students for clinical experiences (Check all that apply).Physical TherapistFirst Experience:Full daysPlease explain:Do not allow first year experience.Half daysOther

Physical TherapistIntermediate Experiences:Full daysHalf daysOtherPlease explain:Due to the intensity of our programs and the complexity of our patients, we accept final, or in limited cases second from final, affiliation students.Physical TherapistFinal ExperienceInternship (6 months or longer)Specialty experienceHalf daysOtherHalf daysOtherOtherPhysical Therapist AssistantFirst Experience:Full daysPlease explain:Do not allow first year experience.Physical Therapist AssistantIntermediate Experiences:Full daysPhysical Therapist AssistantFinal ExperienceOtherPTIndicate which months you will accept students for any single full-time (36 hrs/wk) clinical ustSeptemberOctoberNovemberDecemberIndicate which months you will accept students for any one part-time ( 36 hrs/wk) clinical ustSeptemberOctoberNovemberDecemberPTAIndicate which months you will accept students for any single full-time (36 hrs/wk) clinical ustSeptemberOctoberNovemberDecemberIndicate which months you will accept students for any one part-time ( 36 hrs/wk) clinical ustSeptemberOctoberNovemberDecemberAverage number of PT students affiliating per year.:25Average number of PTA students affiliating per year.:0

Is your clinical site willing to offer reasonable accommodations for students under ADA?YesPlease explain:NoWhat is the procedure for managing students whose performance is below expectations or unsafe?:An individualized meeting with the student, clinical instructor, and clinical site coordinator is performed. Verbal communication with the school isconducted. If necessary, an Action Plan/Learning Contract will be initiated for the student. Coaching is provided for the student, and plans forremediation are developed in collaboration with the academic institution. There is the potential for discontinuation or dismissal from the clinicalexperience for safety and professional issues.Explain what provisions are made for students if the clinical instructor is ill or away from the clinical site. br/ (Answer if the clinical center employs only one PT or PTA.):not applicable.Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Clinical Site's Learning Objectives and Assessment08/16/16 07:18 AMClinical Site's Learning Objectives and AssessmentDoes your clinical site provide written clinical education objectives to students?YesNoAre all professional staff members who provide physical therapy services acquainted with the clinical site's learning objectives?YesNoWhen do the CCCE and/or CI typically discuss the clinical site's learning objectives with students? (Check all that apply)At end of clinical experienceAt mid-clinical experienceBeginning of the clinical experienceDailyWeeklyOtherIndicate which of the following methods are typically utilized to inform students about their clinical performance? (Check all that apply)As per student request in addition to formal and ongoingwritten & oral feedbackOngoing feedback throughout the clinicalStudent self-assessment throughout the clinicalWritten and oral mid-evaluationWritten and oral summative final evaluationOtherSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.Student RequirementsStudent RequirementsDo students need to contact the clinical site for specific work hours related to the clinical experience?YesPlease explain:NoDo students receive the same official holidays as staff?YesPlease explain:NoDoes your clinical site require a student interview?YesPlease explain:NoIndicate the time the student should report to the clinical site on the first day of the experience.8:00 AMIs a Mantoux TB test (PPD) required?a) one stepYesNob) two stepYesNo06/11/15 01:14 PM

Is a Rubella Titer Test or immunization required?YesPlease explain:NoAre any other health tests/immunizations required prior to the clinical experience? If yes, please specify:YesPlease explain:No10 panel drug screen (within 30 days prior to start date). Also require rubeola and varicella zoster.How is this information communicated to the clinic? Provide fax number if required.:Fax written packet to campus specific student coordinator. Can also mail hard copy. Must be received before or on day 1 of affiliation in order tostart.How current are student physical exam records required to be?:within 1 year from start date.Are any other health tests or immunizations required on-site? If yes, please specify:YesNoIs the student required to provide proof of any other training prior to orientation at your facility? If yes, please list.YesPlease explain:No- Age related competency - Code of conduct Via completion of Kessler specific training modules.Indicate which of the following are required by your facility prior to the clinical education experience:Child clearanceCriminal background checkDrug screeningHIPAA educationOSHA educationProof of student health clearanceOtherIs a criminal background check required (e.g., Criminal Offender Record Information)? If yes, please indicate which background check is required and time frame.YesPlease explain:NoMust be completed within 90 days prior to start date; must include federal and each state in which the student has resided.Is a child abuse clearance required?YesPlease explain:NoIs the student responsible for the cost of required clearances?YesPlease explain:NoIs the student required to submit to a drug test? If yes, please describe parameters.YesPlease explain:NoMust be 10 panel drug screen completed within 30 days prior to start date.Is medical testing available on-site for students?YesPlease explain:NoOther requirements: (On-site orientation, sign an ethics statement, sign a confidentiality statement.):On site orientation, sign off on training modules and reading of clinical education materials.If an individual is responsible for Compliance items, please fill out the Compliance contact information below:Compliance Contact Person Name:Compliance Contact Person Phone NumberPhone Number:Ext:Compliance Contact Person Email:Section Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed.

Special Information06/11/15 01:14 PMSpecial InformationDo you require a case study or inservice from all students (part-time and full-time)?YesPlease explain:NoMay be case study, inservice or projectDo you require any additional written or verbal work from the student (e.g., article critiques, journal review, patient/client education handout/brochure)?YesPlease explain:NoJournal reviews are recommended and may be part of the student's requirements based on university's program guidelines, CI assignment, orspecific student's learning goals. Educational handouts/brochure completion may be part of final project.Does your site have a written policy for missed days due to illness, emergency situations, other? If yes, please summarize.YesPlease explain:NoStudents are allowed one excused absence from the facility for medical or professional reasons (courses, school meeting). One absence forpersonal reasons may be allowed but must be cleared with CI and CCCE prior to start of affiliation and may need to be made up based on thespecific issue. All absences beyond one day will need to be made up through either evening or weekend coverage or through extension ofaffiliation.Will the student have access to the Internet at the clinical site?YesPlease explain:NoOnly through CI access or through public computeres. Students not provided with personal internet access.Is there a facility/student dress code?YesNoIs emergency health care available for students?YesNoIs the student responsible for emergency health care costs?YesNoIs other non-emergency medical care available to students?YesNoIs the student required to have proof of health insurance?YesNoIs the student required to provide proof of OSHA training?YesNoIs the student required to provide proof of HIPAA training?YesNoIs the student required to attest to an understanding of the benefits and risks of Hepatitis-B immunization?YesNoIs the student required to be CPR certified? (Please note if a specific course is required).YesNoCan the student receive CPR certification while on-site?YesNoIs the student required to be certified in First Aid?YesNoCan the student receive First Aid certification on-site?YesNoSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.

This section has been completed.Student Schedule06/11/15 01:14 PMStudent ScheduleIndicate which of the following best describes the typical student work schedule:Standard 8 hour dayDescribe the schedule(s) the student is expected to follow during the clinical experience:The schedule is typically from 8 am to 5 pm, varying depending on the expectations of the clinical instructor, the caseload and the time requiredfor the student to meet professional/clinical goals. Additional time may be required on days when there are meetings, in-services, or educationalprograms to further develop the student.Is physical therapy provided on the weekends?YesNoSection Sign Off:Click the box below to indicate you have reviewed and finished with this section of the survey.This section has been completed."Key fields have been marked with an asterisks. Please see the CSIF Web Help Manual for more details about Key Fields"Software 2007-2019 Liaison International.

Broward College, FL Brown Mackie College, IN Bryant & Stratton College - Orchard Park, NY Bryant & Stratton College - Parma, OH . Major: Physical Therapy Degree: Doctor of Physical Therapy Summary of Primary Employment (For current and previous four positions since graduation from college; start with most current)