ASHA Practicum Clock Hours Editable Detailed Form

ASHA Practicum Clock Hours Editable Detailed Form
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This is an EDITABLE Microsoft word form to record practicum clock hours according to ASHA regulations (2015). I created it during my own practicum during my internship. It is appropriate for use during both graduate and undergraduate practicum clinical or educational experiences.

It contains the following sections:
Date & Time of session
Client (use initials only for HIPPA privacy)
Child
Adult
Assessment (Ax)
Treatment (Tx)
Observation (Obs)
Minutes
Articulation
Fluency
Voice
Swallowing
Communication Modalities (i.e. AAC, speech supplementation, visual supports)
Expressive/Receptive Communication
Cognition
Social
Hearing
Other (i.e. collaboration but note that this does not qualify as ASHA clock hours).
Entered hours into database (i.e. CALIPSO Client; note you can edit database name)
Submitted for approval & Supervisor

Note: adjust margins in page settings to narrow if this document saves as two pages.
Total Pages
1
Answer Key
N/A
Teaching Duration
N/A

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ASHA Practicum Clock Hours Editable Detailed Form