ACSLPA Application Form
#620, 4445 Calgary Trail NW
Edmonton, AB T6H 5R7
Ph: 780-944-1609 / 1-800-537-0589
Fax: 780-408-3925
[email protected] / www.acslpa.ca
Audiology
Application Package
Dear Applicant,
To apply for registration and a practice permit, please complete and submit the attached application form to
ACSLPA. The additional documents that you must submit as part of your application process will depend on the
type of applicant you are. We have included checklists to help you submit all the appropriate documents.
Please note:
●
Registration is mandatory. As a speech-language pathologist or audiologist, you must register with
ACSLPA before working/volunteering and using these professional titles in Alberta.
●
Please start the registration process early so that ACSLPA has sufficient time to process your application
before your employment or volunteer start date. ACSLPA will notify you by email and/or telephone if
more information is needed.
●
We will only begin to review your application after ACSLPA has received all the required documents. If you
are requesting information from a university, association or college, you must ask that they send the
information directly to the ACSLPA office. We will not process incomplete applications.
●
You must include the $220.00 application fee with your application for registration. The application fee is
non-refundable, even if your application for registration is denied, withdrawn, or incomplete.
●
We do not accept fax or email application forms, transcripts, or other documents. We need all original
documents sent to us.
●
ACSLPA will only issue a practice permit after you complete all requirements for registration, and you can
only work/volunteer as a speech-language pathologist or audiologist in Alberta if your application for
registration is successful.
If you have any questions about the application process, please contact the ACSLPA office at 1-800-537-0589 or
780-944-1609.
Please submit your completed application to:
Alberta College of Speech-Language Pathologists and Audiologists (ACSLPA)
#620, 4445 Calgary Trail NW
ACSLPA Application Form
| 2
There are five different applicant types:
1.
Graduate of a Canadian Accredited Program
(not registered with another SLP/Audiology regulatory body in Canada)
Applicable if you have completed your education in Canada and you are not yet registered as an SLP or
audiologist in another province (this includes new graduates who have not yet been employed; SLPs or
audiologists who have been working but come from an unregulated Canadian jurisdiction (e.g., PEI or the
territories); Canadian graduates who have been working outside Canada).
2.
New Graduate of a United States (US) ASHA Accredited Program
Applicable if you have completed your education in the US within the previous three years.
3.
Applicants registered with another Provincial SLP/Audiology Regulatory Body in Canada
Applicable if you are moving to practice in Alberta from British Columbia (BC), Saskatchewan (SK),
Manitoba (MB), Ontario (ON), Quebec (QC), Newfoundland (NL), New Brunswick (NB) or Nova Scotia (NS).
4.
Applicants registered with an SLP/Audiology licensing body in the US that has substantially equivalent
requirements for registration to ACSLPA.
5.
All other applicants
(e.g., applicants educated outside of Canada or the US, graduates of non-accredited Canadian and
American programs, applicants from American jurisdictions where application requirements are not
substantially equivalent to ACSLPA’s).
Review the applicant types above and choose the category that applies to you. Click on the category to view the
documents you will need to submit.
If you need more information on the required documents and the
ALBERTA COLLEGE OF SPEECH-LANGUAGE
PATHOLOGISTS AND AUDIOLOGISTS (ACSLPA)
#620, 4445 Calgary Trail NW · Edmonton, AB T6H 5R7
PH 780-944-1609 | TF 1-800-537-0589 | FX 780-408-3925
[email protected] | www.acslpa.ca
REGISTRATION AND PRACTICE PERMIT APPLICATION
FORM
1.
Personal
Information
Surname
Given Name
Middle Name
Maiden Name or Other Names (if applicable)
Preferred First Name (if applicable)Birth Date (month/day/year)
−
REQUIRED -
/ /
❑ Female ❑
Male
2.
Contact Information
Address
City / Town
Province
Postal Code
( )
Country
( )
Home Phone
Cell Phone
3.
Profession
❑ Speech-Language Pathologist
❑ Audiologist
4.
Language Proficiency
First/Primary language:
Language of your speech-language pathology or audiology training:
Other languages you have fluency in (including ASL):
FOR OFFICE USE ONLY
Process Date:
Amount: $
Auth/Dep. Ref #:
PIC/VSC:
❑
T
❑
H
❑ Other
Reg #:
Type:
Effective:
Processed by:
5.
Educational Background
Degrees
Location
Bachelor Major Grad Year University Province & Country App
Masters Major Grad Year University Province & Country App
Doctorate Major Grad Year University Province & Country App
I have an AuD or PhD
and would like to apply to use the protected title “Doctor” or “Dr.” when providing
a health service.
NOTE: ACSLPA requires official transcripts confirming the date on which you officially received your doctoral
degree; documents must be original and sent to ACSLPA directly from the university where you received your
qualifications. Original electronic documents (e.g. transcripts and credential assessments) from post-secondary
and recognized assessment agencies that can be accessed by secure login site will be accepted as original
documents.
6.
Current Qualifications
Hours practiced as a registered speech-language pathologist or audiologist during the last 5 years:
(do not include student / practicum hours)
Year
Number of
Hours
Note: Hours reported may be subject to verification.
7.
Employment History
(SLP/Audiologist related only)
Details of last 5 years of employment as a registered speech-language pathologist or audiologist
(do not include student positions).Employment Dates (Start to End) Position Employer Name
Street Address City / Town Province/State
Country Telephone
Employment Dates (Start to End) Position
Employer Name Street Address City / Town Province/State
Country Telephone
Employment Dates (Start to End) Position
Employer Name
Street Address City / Town Province/State
Country Telephone
8.
Pending Alberta Employment
(including contract and volunteer positions)
Please check which best describes your situation in regard to employment in Alberta:
❑
Seeking work in field
❑
Not seeking work in field
❑
Have pending employment (please complete the following):
Primary Place of Employment (Institution, Clinic, Agency) Hours / week Phone Number
Address City / Town
Province Postal Code
Work Email (Optional) Supervisor’s Name Anticipated Start Date
Secondary Place of Employment (Institution, Clinic, Agency) Hours / week Phone Number
Address City / Town Province
Postal Code
Work Email (Optional) Supervisor’s Name Anticipated Start Date
COMPLETE THIS SECTION ONLY IN THE CASE OF PENDING EMPLOYMENT AS AN SLP OR AUDIOLOGIST IN ALBERTA
If you have more than one employer, complete all segments for your primary and secondary employment.Main Scope of Practice
Direct Patient Care
Consulting
Administration
Teaching
Research
Other: ________________
Primary
❑
❑
❑
❑
❑
❑
Secondary
❑
❑
❑
❑
❑
❑
Which age category best describes your
clients?
Pediatric
Adult
Geriatric
All Ages
Primary
❑
❑
❑
❑
Secondary
❑
❑
❑
❑
Which classification best describes
the level of your clients?
Acute
Rehabilitation
Long Term/Chronic
Mixed
Primary
❑
❑
❑
❑
Secondary
❑
❑
❑
❑
9.
Registration / Certification / Licensure
Have you previously applied for or been issued a registration number by the Alberta College of Speech-Language Pathologists and
Audiologists? ❑ Yes ❑ No
Indicate other jurisdiction(s) where you are currently or have been registered, certified, or licensed.
Regulatory Body/Professional Association Province/State/Country License/Certification Number Expiry Date Regulatory Body/Professional Association Province/State/Country License/Certification Number Expiry Date
Indicate other regulatory colleges in Alberta where you are currently or have been registered, certified or licensed.
Regulatory Body/Professional Association Province/State/Country License/Certification Number Expiry Date Regulatory Body/Professional Association Province/State/Country License/Certification Number Expiry Date
10.
Conduct
Answer
each of the following statements by entering ‘True’ or ‘False’ in the box. If your answer(s) to any of the
questions below is false, please provide details on a separate sheet of paper.
True
False
To the best of my knowledge neither my professional conduct nor my practice of
speech-language pathology or audiology is under investigation in any jurisdiction.
❑
❑
I have not been subject of a finding of unprofessional conduct in any jurisdiction.
❑
❑
I have never pleaded guilty or been found guilty of a criminal offence in Canada or an
offence of a similar nature in a jurisdiction outside of Canada, for which I have not received
a pardon.
❑
❑
There has been no civil judgment (including negligence) against me with respect to my
professional practice.
❑
❑
I am not the subject of disciplinary proceedings in any jurisdiction.
❑
❑
I have never had any conditions related to conduct or disciplinary proceedings imposed on
my practice permit in any jurisdiction.
(Do not include conditions imposed as a routine part of initial registration, such as completion of jurisprudence training or supervised practice requirements, or conditions that specify language restrictions, etc.)❑
❑
11.
Professional Liability Insurance
All applicants must provide evidence of holding their own professional liability insurance policy (PLI) for a
minimum of $2,000,000 (two million dollars) professional liability insurance (PLI) in order to obtain registration
and a practice permit. An extended reporting period for a minimum of two years is also required. For further
information, refer to the Registration Handbook.
❑ Self-Coverage*
Name of Policy
Policy and Certificate Numbers
Policyholder
Policy provider
Amount of coverage
Start and end dates
*Please include a copy of your policy.
ACSLPA is committed to safeguarding the personal information of registrants as stated in our Privacy Policy and
Registration Handbook (available on the ACSLPA website).
12.
Payment
ANNUAL DUES
(Canadian Funds)
❑ Application Fee (non-refundable) $220.00
AND ANNUAL DUES
(Canadian Funds)
$55.00 X number of months remaining in the year of
registration; must be registered for the month in
which employment commences
$55.00 x _______ months = $____________
METHOD OF PAYMENT
(Canadian Funds)
Payments will be in two installments as follows:
•
Application fee
•
Practice permit/registration fee
❑ Cheque payable to ACSLPA
❑
VISA | MasterCard | VISA Debit
Credit Card #:
Expiry Date:
Name on Card:
Signature:
13.
Declaration
With my signature below, I give the Alberta College of Speech-Language Pathologists and Audiologists (ACSLPA) my permission to collect from and disclose information to other regulatory organizations, professional associations, educational institutions, previous and present employers for purposes related to the assessment of my registration and qualifications.
I understand that I must be registered and hold a current practice permit with ACSLPA as an audiologist or speech-language pathologist in Alberta to use the protected titles of the applicable profession. These include “speech-language pathologist”, “speech therapist”, “speech pathologist”, “audiologist”, SLP, R.SLP, Aud and R.Aud. I hereby attest that I will not provide any audiology or speech-language pathology services in the province of Alberta if I am not a Registered member of ACSLPA.
I hereby attest that I will not provide any audiology or speech-language pathology services in the province of Alberta if I am not a Registered member of ACSLPA.
I understand that, as a Registered member, information required by the Health ProfessionsAct will appear on the Register on ACSLPA’s website. I further understand that I will receive emails from ACSLPA that are critical to maintaining registration.
I understand that registration information will be provided to the Alberta Provider Directory as described in ACSLPA’s communication and information management policies.
I will not practice without holding professional liability insurance for a minimum of $2,000,000.00 per claim, with an extended reporting period of a minimum of two years.
I understand that it is my responsibility to notify ACSLPA immediately of any change of name, mailing address, contact telephone number, or email address.
I will advise ACSLPA immediately in writing:
(i) should I be charged or convicted of an offence under the Criminal Code (Canada);
(ii) should a finding of or proceeding for unprofessional conduct or incapacity in Alberta or in any other jurisdiction be made or commenced against me in relation to the profession or any other health profession. If there is a finding of unprofessional conduct, I will provide a copy to the Registrar.
(iii) should I be denied registration, licensure or similar status by a regulatory body in Alberta that is responsible for the regulation of another health profession or by a regulatory body in another jurisdiction in or out of Canada that is responsible for the regulation of the profession or another health profession; or
(iv) should my registration, licensure or similar status in Alberta in relation to another health profession or in any other jurisdiction in or out of Canada in relation to the profession or another health profession be revoked or suspended.
(v) should any civil judgement (including negligence) be made against me with respect to my professional practice. I declare that all the information I have provided is complete and truthful. I understand that my application may be canceled and registration refused if ACSLPA determines I have provided inaccurate information, omitted any information or documentation required, or submitted documents that have been altered, tampered with or forged during the application process.
I understand that making a false or misleading statement, which may include omission of required information, will be considered to be an act of professional misconduct and may lead to cancellation or suspension of my practice permit or other disciplinary action.
Signature: __________________________________________ Date: __________________________________
Please print your completed application, sign and mail or courier to:
#620, 4445 Calgary Trail NW | Edmonton, AB | T6H 5R7 | CanadaAlberta College of Speech-Language Pathologists and Audiologists | Reference Request approved June 2019|p.1
REFERENCE REQUEST FORM
Please obtain from someone who is familiar with your recent practice.
1.
Applicant
Information (this section may be completed prior to forwarding the form to your reference)
Surname
Given Name
Email Address
Phone Number
This form has been created to assist ACSLPA in determining if the applicant is qualified to be registered as a
professional speech-language pathologist (SLP) or audiologist in the province of Alberta, Canada. Registered SLPs
and audiologists are entitled to practice independently and provide professional health services to the public. They
are bound by a professional Code of Ethics and Standards of Practice and may be investigated and disciplined for
reasons of unprofessional conduct, including incompetent or unethical practice. Your responses may be shared by
ACSLPA with the applicant and may be presented to the Registrar, Registration Committee, or an application review
panel as needed.
2.
For Reference: in order to complete this form, you must:
(a)
Be recognized as a qualified SLP or audiologist by the appropriate authority in the jurisdiction where you
practice, and
(b)
Must have direct knowledge of the applicant’s clinical practice and employment history for the period that
you are referencing.
3.
Reference Information
Name of Reference:
❑
Speech-Language Pathologist
❑
Audiologist
Email Address:
Phone Number:
Are you recognized as a qualified SLP or Audiologist by the appropriate authority in the jurisdiction where you
practice?
❑
YES
❑
NO
Please provide the name of the authority that recognizes SLP and audiology qualifications in your jurisdiction (name
of regulatory body, professional society or association):
Registration number: ___________________
How many years have you practiced as an SLP or audiologist? _______________
Please state your relationship to the applicant (i.e., employer, supervisor, practicum supervisor, professor,
colleague)
ALBERTA COLLEGE OF SPEECH-LANGUAGE
PATHOLOGISTS AND AUDIOLOGISTS (ACSLPA)
#620, 4445 Calgary Trail NW · Edmonton, AB T6H 5R7
Phone: 780-944-1609 / 1-800-537-0589 · Fax: 780-408-3925
Alberta College of Speech-Language Pathologists and Audiologists | Reference Request approved June 2019|p.2
What is the time period during which you worked with/supervised the applicant?
___________ to ______________
How familiar are you with the applicant’s practice for the time period you are referencing (choose one):
❑
Not very familiar
❑
Familiar
❑
Very familiar
To your knowledge, what were the applicant’s clinical responsibilities during this time?
(e.g., full clinical scope of
practice as an SLP or audiologist, student, worked in an assistant role during this time, etc.).
To your knowledge, where was the applicant employed during this time?
To your knowledge, during this time was the applicant working:
❑
Casually (few hours here and there)
❑
Part-time
❑
Full-time
Based on your knowledge of the applicant’s practice, would you have any concerns with having them practice SLP
or audiology independently and without supervision?
❑
YES
❑
NO
If you answered YES, we will contact you for more information about your concerns, or you can provide more
information on a separate sheet of paper.
Based on your knowledge of the applicant, do you have any concerns with their professional character or
reputation?
❑
YES
❑
NO
If you answered YES, we will contact you for more information about your concerns, or you can provide more
information on a separate sheet of paper.
Please provide any additional feedback that you would like to provide to ACSLPA: (more information can be provided
on a separate sheet of paper.)
Signature:
Date:
Please print your completed form, sign and email, mail or courier to:
1Definitions of ACSLPA Registration Categories can be found in the Registration Handbook available on the ACSLPA website.
VERIFICATION OF REGISTRATION FORM
for Jurisdictions Outside of Canada
Regulatory History:
1.
Has there been a period this person was not registered/licensed in your jurisdiction after their
first registration/licensure date?
☐
Yes
☐
No
2.
Are there any current restrictions/terms/limitations to this person’s registration or licence to
practise in your jurisdiction?
☐
Yes
☐
No
3.
Has this person been the subject of any disciplinary action by your organization?
☐
Yes
☐
No
4.
Is this person the subject of any unresolved complaints concerning misconduct, incompetence
or incapacity?
☐
Yes
☐
No
5.
Has this person’s
registration or license ever been suspended or revoked?
☐
Yes
☐
No
*If you have answered “yes” to any of the questions, please attach additional information
This form serves as the official verification that the above-named individual holds (or held) the certificate of registration or
license referred to above.
Name
____________________________
Signature:
Title
Date
Affix official
seal here
Name of Regulatory/Licensing Body
*Note:
Applicants from the regulated jurisdictions of British Columbia, Saskatchewan, Manitoba, Ontario, Quebec,
New Brunswick, Newfoundland and Nova Scotia must ask their regulatory organization to submit a Verification
of Registration Form on their behalf. Applicants from all other jurisdictions must use this form.
Registration number:
Province/State:
First name:
Middle name(s):
Last name:
Previous name(s) if applicable:
Address (Home or Business):
Profession:
❑
Audiologist
❑
Speech-Language Pathologist
Telephone number:
Email address:
Registration category
1:
❑
Registered/Active
❑
Registered with Conditions
❑
Non-Practicing
❑
Honourary
❑
Former Member
❑
Other:
Currency of Practice/Qualification Hours (if available):
Hours in the most recent 5 years.
Initial registration date:
Effective date of current status:
Expiry date of current status:
This form is to be completed by the applicant’s
regulator or licensing body and mailed directly to:
Alberta College of Speech-Language Pathologists and Audiologists
#620, 4445 Calgary Trail NW, Edmonton, Alberta, Canada T6H 5R7
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
1
SUMMARY OF CLINICAL PRACTICE HOURS
|
AUDIOLOGY
OVERVIEW OF REQUIREMENTS
1. A minimum of 350 hours total SUPERVISED CLINICAL PRACTICE HOURS required.
2. A maximum of 50 of these hours may be simulated practice hours (see definition below).
3. Clinical practice hours must include:
A. At least 20 hours related to speech-language pathology
B. Minimum 300 hours CLIENT CONTACT in audiology, distributed as the following:
I.
At least 50 hours with CHILDREN
II.
At least 50 hours with ADULTS
III.
At least 100 hours ASSESSMENT / IDENTIFICATION
IV.
At least 50 hours INTERVENTION / TREATMENT
DEFINITIONS
“Client Contact”
means a supervised practical learning experience where the student clinician actively participates in patient/client service. The patient/client
or significant communication partner (i.e. spouse, parent, work colleague) need not be present for all activities, but these should be focused on the client’s
specific needs (e.g. team meetings, discussion with supervisor). This category is not meant to capture activities that are of a general nature (e.g. delivering a
presentation on a disorder type). The participation may be unaided or assisted:
Unaided participation-patient/client services provided by student where the student’s supervisor is readily available to assist or support the student but does not
directly participate in the services provided.
Assisted participation-patient/client services provided by student where the student’s supervisor directs or guides the services provided.
Client contact may be undertaken
in person
, or
virtually:
In-person care
is
the in-person provision of services to clients
Virtual care
is
where
health care services are provided at a distance, using information and digital communications, technologies and processes. It is
the responsibility of the student’s clinical supervisor to ensure that virtual care is appropriate for the clinical services being provided.
Notes:
Observation is intended to serve as an important preparatory experience prior to direct clinical practicum experience in a specific clinical area. While
strongly recommended for students’ clinical development,
time spent observing does not count towards clock hours
.
Ancillary clinical activities such as report writing, record keeping, materials development, and planning for sessions are not considered clock hours and
may not
be counted. Time spent in supervisory conferences in which the supervisee’s clinical skill development is the focus of discussion is
not
counted.
Student clinicians may obtain supervised clinical experience working on their own or working with other professionals and/or student clinicians. It is
assumed, however, that the majority of clinical experiences are obtained by students working independently under supervision.
“Simulation”
means a practical learning experience where the student clinician participates in an activity that utilizes a real-life imitation of a patient/client with
a set of problems. Simulations may be computerized or may involve an individual who is trained to act as a real patient/client.
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
2
APPLICANT INFORMATION
Surname:
First Name:
Name of University:
SUMMARY OF CLINICAL PRACTICE HOURS (AUD)
SECTION A | ESSENTIAL TOPICS
Your Clinical Practice Hours MUST include a variety of the following topics1
CLIENT CONTACT Simulated
Practice2
Assessment (Identification) Intervention (Treatment)
Children Adults Children Adults Max of 50 hrs Combined
Hearing Measurement Audiological Assessment
Electrophysiological & Other Diagnostic Measurements
Amplification (Systems, Selection, Fitting, Verification, & Validation) Implantable Hearing Devices
SECTION A TOTAL:
_______________
1. Subtotal: 2. Subtotal: 3. Subtotal: 4. Subtotal: 5. Subtotal:__________ __________ __________ __________ __________
1 Applicants must demonstrate clinical practice hours in a variety of the below topics; however, there is no prescribed minimum number of hours that must be completed in each. 2 Simulated hours may be completed in any topic and may be in the areas of assessment (identification) and/or intervention (treatment).
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
3
3 Note that these are not required topics but may be used to supplement total practice hours to meet the requirements outlined at the top of page 1 of this form.
SECTION B | OTHER TOPICS
If your total hours in Section A do not meet the requirements outlined at the top of page 1 of this form, please provide details of additional clinical practice hours. These may include following topics3:
CLIENT CONTACT
Simulated Practice Assessment (Identification) Intervention (Treatment)
Children Adults Children Adults Max of 50 hrs Combined
Calibration & Maintenance of Instrumentation
Auditory & Vestibular Disorders Involving Both Peripheral & Central Pathways of Hearing
Assessment & Management of Tinnitus, Including Hyperacusis
Habilitation & Rehabilitation Procedures Applied to Children, Adults, the Elderly, & Specific Populations (e.g., Developmental Delay, Occupational Hearing Loss)
Identification (including screening) and Prevention Other (please specify):
SECTION B TOTAL:
_______________
6. Subtotal: 7. Subtotal: 8. Subtotal: 9. Subtotal: 10. Subtotal:
__________ __________ __________ __________ __________
SECTION C | SPEECH-LANGUAGE PATHOLOGY
Minimum of 20 hours
CLIENT CONTACT Simulated
Practice Assessment (Identification) Intervention (Treatment)
Speech-language pathology assessment, intervention, and/or prevention activities:
SECTION C TOTAL:
_______________
11. Subtotal: 12. Subtotal: 13. Subtotal: 14. Subtotal: 15. Subtotal: __________ __________ __________ __________ __________
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
4
SECTION D | DISTRIBUTION OF CLINICAL PRACTICUM HOURS
TOTAL HOURSTOTAL HOURS with Children
= sum of subtotals 1, 3, 6, and 8:
Minimum 50 hours
TOTAL HOURS with Adults
= sum of subtotals 2, 4, 7, and 9:
Minimum 50 hours
TOTAL HOURS of Speech-Language Pathology
= sum of subtotals 11 - 15:
Minimum 20 hours
TOTAL HOURS of Assessment / Identification
= sum of subtotals 1, 2, 6, & 7
Minimum 100 hours
TOTAL HOURS of Intervention / Treatment
= sum of subtotals 3, 4, 8, and 9:
Minimum 50 hours
TOTAL HOURS of Simulation
= sum of subtotals 5, 10, and 15:
Maximum 50 hours
FINAL TOTAL = sum of Section A + Section B + Section C:
____________________I verify that the summary of clinical practice hours above was completed within the program of:
Name of University:
Degree / Name of Program:
Program Director’s Name (Please Print):
Program Director’s Work Email Address & Telephone Number:
Program Director’s Signature:
Date:
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
5
DEFINITIONS OF DISORDER TYPES |
AUDIOLOGY
Section A: Essential Topics
HEARING MEASUREMENT:
Basic pure tone assessment.
AUDIOLOGICAL ASSESSMENT:
Conduct interviews, obtains case history
Basic audiological assessment appropriate across the lifespan (otoscopy, pure-tone
assessment, immittance, speech testing, masking), interpretation of results, clinical
decision analyses and clinical counseling. Provide recommendations and make referrals,
as appropriate
.
ELECTROPHYSIOLOGICAL AND OTHER DIAGNOSTIC
MEASUREMENTS:
Auditory evoked response testing and evaluation/interpretation; otoacoustic emission
testing/screening and interpretation.
AMPLIFICATION:
Assess hearing needs and appropriate hearing aid selection for all ages, earmold
impressions, appropriate earmold selection, verification of hearing aid fittings, hearing aid
follow-up/adjustments. Earmold and hearing aid shell modification, hearing aid trouble
shooting. Provide information counselling.
IMPLANTABLE HEARING DEVICES:
Testing, evaluation, fitting and follow up for cochlear implants (CI) and other implantable
Summary of Clinical Practice Hours – Audiology document for ACSLPA use only. Before use, compare all print copies to the official electronic version on the ACSLPA website. December 2020 Page
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