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Appendix A.4.A

CERTIFIED CHIROPRACTIC CLINICAL ASSISTANT

WORK PROCESS SCHEDULE

AND

RELATED TECHNICAL INSTRUCTION OUTLINE

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Appendix A.4.A WORK PROCESS SCHEDULE

CERTIFIED CHIROPRACTIC CLINICAL ASSISTANT O*NET-SOC CODE: 31-9092.00 RAPIDS CODE: 1085

This schedule is attached to and a part of these Standards for the above identified occupation. 1. TYPE OF OCCUPATION

Time-based Competency-based Hybrid 2. TERM OF APPRENTICESHIP

The term of the occupation is two years with an OJL attainment of 4,000 hours, through the attainment of job competencies, and supplemented by the minimum required 288 hours of related instruction.

3. RATIO OF APPRENTICES TO JOURNEYWORKERS

Consistent with proper supervision, training, safety, continuity of employment throughout the apprenticeship, the ratio of apprentices to mentors will be: one (1) apprentice may be employed in each clinical site employing one (1) Doctor of Chiropractor or Licensed Chiropractor Physician and two (2) apprentices may be employed in each administrative site employing one (1) Office/Business Manager or CCCA.

4. APPRENTICE WAGE SCHEDULE

Apprentices shall be paid a progressively increasing schedule of wages based on either a percentage or a dollar amount of the current hourly Certified Chiropractic Clinical Assistant journeyworker wage rate, which is: $XX.XX per hour.

1st 6 months + 1,000 OJL hours = 60 percent 2nd 6 months + 1,000 OJL hours = 70 percent 3rd 6 months + 1,000 OJL hours = 80 percent 4th 6 months + 1,000 OJL hours = 90 percent

Note: Journeyworker hourly wage rate based on the Alaska mean wage data: http://live.laborstats.alaska.gov/wage). 5. WORK PROCESS SCHEDULE (OJL) (See attached Work Process Schedule)

6. RELATED TECHNICAL INSTRUCTION OUTLINE (See attached Related Instruction Outline)

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Appendix A.4.A WORK PROCESS SCHEDULE

CERTIFIED CHIROPRACTIC CLINICAL ASSISTANT O*NET-SOC CODE: 31-9092.00 RAPIDS CODE: 1085

During the term of apprenticeship, the Apprentice shall receive such instruction and experience, in all branches of the occupation, as is necessary to develop a practical and versatile worker. Major processes in which Apprentices will be trained (although not necessarily in the order listed) and approximate hours (not necessarily continuous) to be spent in each are as follows:

Certified Chiropractic Clinical Assistant

Work Processes Demonstrated Competence

Approximate OJT Hours

A. General Office Management 1. Maintain, track license/certificate of healthcare personnel 2. Coordinate patient/office communication 3. Recognize and prevent office hazards 4. Respond to office emergencies 5. Assist with incoming/outgoing mail, email, and telephone 6. Assist with accounts payable & receivable 7. Inventory and order office equipment and supplies 8. Provide/coordinate office maintenance 9. Maintain and control therapeutic supplies and inventory 10. Maintain and update procedure manuals

I 100

B. Coordinate and Schedule Appointments 1. Schedule patient’s appointments 2. Coordinate with doctor and staff schedules 3. Triage patients

II 100

C. Administrative Intake of Patient and Billing 1. Obtain referrals and authorizations for treatment 2. Input and manage patient electronic and paper records 3. Know billing and procedure codes and appropriate forms

e.g., intake and consent forms 4. Coordinate insurance information 5. Collect copayments and payments on account 6. Provide billing statements to patient 7. Submit insurance claims

III 400

D. Maintain Health Information and Confidentiality 1. Provide for patient confidentiality - HIPAA 2. Know and apply ethics and professional boundaries 3. Document all patient information 4. Obtain and file consents 5. Prepare patient chart of office visit 6. File office data 7. Transfer patient/client records

IV 400

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E. Provide/Maintain Aseptic Environment

1. Wash hands 2. Maintain clean office and treatment room environment 3. Sterilize exam and therapeutic instruments 4. Don gloves as appropriate 5. Dispose of hazardous waste

V 200

F. Prepare Patient for Examination 1. Know basic terminology and general procedures for

obtaining vitals 2. Obtain vital signs 3. Obtain health history 4. Measure patient’s height, weight, blood pressure, … 5. Set-up for exam and/or procedure 6. Prepare patient as appropriate for exam or procedure

VI 600

G. Assist with Chiropractic Physician Orders 1. Set/up assist with therapeutic procedures 2. Perform physical exams and other tests 3. Provide patient counseling/education 4. Coordinate transportation of the patient 5. Release patient

VII 900

H. Perform Clinical and Therapeutic Procedures 1. Calibrate & standardize equipment 2. Communicate with professional and common terminology 3. Know and apply therapeutic modalities and procedures –

e.g., safe therapy setup and how to use ice and heat 4. Recognize indications and contraindications for common

modalities, e.g., indications such as tight muscles or swelling, and contraindications such as pregnancy or cancer.

5. Know X-ray safety, e.g., ask females about pregnancy 6. Administer therapeutic procedures under the supervision of

a Chiropractic Physician

VIII 900

I. Perform Radiologic Imaging 1. Practice radiation safety for patients and workers 2. Know professional and legal responsibilities for health care

workers 3. Obtain patient consent for imaging 4. Maintain professional credentials 5. Know fundamentals of radiology and radiation physics 6. Know operation, maintenance, and calibration of

radiological equipment 7. Practice patient education, safety, and comfort

IX 200

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8. Position patient properly for quality image

J. Maintain Professional Responsibilities 1. Maintain personal hygiene 2. Participate in continuing education 3. Participate in community health activities 4. Serve as mentor to other health care professionals 5. Maintain basic life support certificate 6. Maintain professional network 7. Participate in performance improvement 8. Perform within legal & ethical boundaries

X 200

Total Hours 4,000

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Appendix A.4A RELATED INSTRUCTION OUTLINE

CERTIFIED CHIROPRACTIC CLINICAL ASSISTANT O*NET-SOC CODE: 31-9092.00 RAPIDS CODE: 1085

Certified Chiropractic Clinical Assistant Training

Tennessee Chiropractic Association 2123 8th Avenue S

Nashville, TN 37204 Phone: (615) 383-6231

Fax: (615) 383-6233 Web Site http://www.tnchiro.com/professional-development/cta-program

Approximant Cost $215.00 Delivery CD or Online

Certified Chiropractic Clinical Assistant Related Instruction Outline

Estimated RTI Hours

Chapter 1. The Professional Chiropractic Therapy Assistant 1. Qualifications for the Chiropractic Therapy Assistant 2. Responsibilities of the Chiropractic Therapy Assistant

a. Administrative and Clinical Duties b. Human Relations in Healthcare c. Responsibilities of Licensure

6

Chapter 2. Principles of Chiropractic Healthcare 1. Chiropractic Treatment

a. What can patients expect on their first visit b. How does chiropractic correct spinal problems c. How much chiropractic care will a patient need d. How can consumers find the right doctor of chiropractic

2. Chiropractic Approach to Healthcare a. How does chiropractic approach to healthcare work b. Who should see a doctor of chiropractic c. Is chiropractic safe

3. Educational Background of a Chiropractic Physician a. What is the Council of Chiropractic Education (CCE) b. Scope of Chiropractic Practice c. Defining Chiropractic Scope d. Defining Chiropractic Practice

20

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Chapter 2. Principles of Chiropractic Healthcare (continued) 4. Why regulate healthcare professionals?

a. Where are chiropractors licensed b. When a license is granted, what does this mean to the public c. What credentials are required by U.S. jurisdictions d. What should the public expect from a licensed chiropractor e. What happens if a licensee violates these basic rights f. How do you know if a license has been disciplined

Chapter 3. Terminology for Healthcare Professionals 1. Language Fundamentals

a. Common Latin and Greek Word Roots 2. Basic Chiropractic and Medical Terminology

a. Common Prefixes, Suffixes and Descriptions 3. Anatomical Terms and Related Definitions

a. Bodily Planes b. Directional Positions c. Static Positions d. Movements e. Qualifying or Interconnecting Terms

4. Common Musculoskeletal Diagnosis and Definition 5. Common Chiropractic Procedural Terms and Definitions

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Chapter 4. Documentation and Recordkeeping 1. Necessity for Proper Documentation

a. Format b. Necessary Components of the Patient File c. SOAP notes

2. Documentation Special Considerations: Medicare a. P.A.R.T. documented

3. Common Abbreviations

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Chapter 5. Common Duties of the Chiropractic Therapy Assistant 1. Conducting a Complete Health History

a. Structure of Health History Accumulation b. Acronym for Chief Complaint Data

2. Review of Systems Questions • General Overall Health State • Skin, Hair, Nails, Head, Eyes, Ears • Nose, Sinuses, Mouth, Throat, Neck

14

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Chapter 5. Common Duties of the Chiropractic Therapy Assistant (continued) • Axilla, Respiratory, Cardiovascular • Peripheral Vascular, Gastrointestinal, Musculoskeletal • Neurological, Hematological, Endocrine • Functional Assessment, Nutritional Status • Self-Care Behaviors, Self-Concept and Coping • Patients Perception of Health, Knowledge of Chiropractic Care

3. Patient Interaction a. Professional Image b. Assisting Patients in Pain

4. CTA’s supporting Role in Patient Progress Chapter 6. Introduction to Anatomy and Physiology 1. The Skeletal System

a. Bone 2. Axial Skeletal System

a. Bones of the Skull b. The Vertebral Column c. Thoracic Cage (Thorax)

3. Appendicular Skeletal System a. Pectoral (Shoulder) Girdle b. Bones of the Upper Limb c. Pelvic Girdle d. Bones of the Lower Limb

4. Tendons and Bursas 5. Ligaments 6. Articulations (Joints)

a. Key Joints of the Body b. Types of Joints and their Movements

7. Musculoskeletal System a. Muscular System b. Smooth Muscle c. Skeletal Muscle d. Cardiac Muscle

8. Muscle Groups of the Body a. Muscles of the Neck and Back b. Muscles of the Chest c. Muscles of the Abdomen

20

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Chapter 6. Introduction to Anatomy and Physiology (continued) d. Muscles of the Upper Extremity e. Muscles of the Lower Extremity

9. The Nervous System a. Basic Structure and Function

10. Other Body Systems a. Cardiovascular b. Lymphatic c. Endocrine d. Integumentary e. Respiratory f. Digestive g. Accessory Organs h. Urinary i. Immune/Lymphoid j. Reproductive

Chapter 7. Treatment Principles and Procedures Understanding Subluxation 1. Manipulation vs. Mobilization

a. Diversified Technique b. Extremity Manipulation/Adjusting c. Activator Method d. Gonstead Technique e. Cox Flexion/Distraction f. Thompson Technique g. Sacro Occipital Technique (S.O.T.) h. Applied Kinesiology (A.K.) i. Nimmo/Receptor Tonus j. Cranial Technique k. Manipulative/Adjustive Instruments l. Palmer Upper Cervical (H.I.O.) m. Logan Basic Technique n. Metric System o. Pierce-Stillwagon Technique p. Pettibon Systems Adjusting q. Chiropractic Bio Physics (C.B.P.) r. Toggle Recoil Technique s. Blair Upper Cervical Technique t. Directional Non-force Technique (D.N.F.T.) u. Bio Energetic Synchronization Technique (B.E.S.T)

40

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Chapter 7. Treatment Principles and Procedures (continued) v. Atlas Orthogonal Technique (A.O.T.)

2. Therapeutic Massage a. Indications/Contraindications b. Multiple Forms of Manual/Bodywork Therapy

3. Myofascial Stretching a. The Stretch Reflex b. Ballistic Stretching c. Dynamic Stretching d. Active Stretching e. Passive (or Relaxed) Stretching f. Isometric Stretching g. PNF Stretching h. Examples of Specific Muscle Stretches

4. Principles and Procedures of Physiotherapeutic Modalities a. General Adaptation Syndrome (G.A.S)

5. The Healing Process a. The Inflammatory Response Phase b. The Repair Phase c. The Remodeling Phase

6. Goals of Modality Use During the Healing Process 7. Pain Control with Modalities

a. Pain Scales b. V.A.S.

8. Scientific Principles of Therapeutic Modalities a. Frequency vs. Wavelength

9. Electrical Stimulation a. Electricity Basics b. Alterations in Current Related to Treatment Regimens

10. Clinical Application of Electrical Stimulation a. Basic Guidelines for Set-up b. High Volt vs. Low Volt Stimulation c. Interferential Stimulation d. Russian Stimulation, Microcurrent and T.E.N.S Units e. Indications/Contraindications

11. Iontophoresis vs. Phonophoresis a. Ion Transfer Basics with Iontophoresis b. Iontophoresis Equipment and Treatment c. Indications/Contraindications

12. Phonophoresis a. Indications/Contraindications

13. Electromyography Biofeedback a. Biofeedback Basics and Clinical Applications b. Equipment and Treatment Techniques c. Indications/Contraindications

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Chapter 7. Treatment Principles and Procedures (continued) 14. Diathermy

a. Shortwave and Microwave Diathermy b. Indications/Contraindications

15. Cryotherapy and Thermotherapy 16. Cryotherapy

a. Basics of Heat Transfer b. Physiologic Injury Response c. Clinical Applications of Cryotherapy d. Sample Patient “Take Home” Instruction Sheet

17. Thermotherapy a. Physiological Injury Response b. Clinical Applications of Thermotherapy c. Indications/Contraindications d. Sample Patient “Take Home” Instruction Sheet

18. Therapeutic Ultrasound a. Acoustic Physics and Components of Ultrasound Machines b. Physiologic Effects of Ultrasound c. Ultrasound Treatment Techniques d. Clinical Applications for Therapeutic Ultrasound e. Ultrasound Combined with Other Modalities f. Indications/Contraindications

19. Light Therapy (Lasers) a. Basics of Light Therapy b. Types of Lasers c. Clinical Application of Lasers d. Indications/Contraindications

20. Cervical and Lumbar Traction a. Introduction b. Traction Principles c. Physiologic Effect of Traction d. Forms of Traction e. Indications/Contraindications f. Treatment Setup g. Intersegmental Traction (IST) h. Application of IST i. Indications/Contraindications for IST

21. Other Common Chiropractic Modalities a. Indications/Contraindications

22. Safety Precautions Chapter 8. Spinal Rehabilitation Fundamentals 1. Basis for Spinal Rehabilitation

a. Risk Factors for Chronicity b. Rehabilitation Essentials c. S.A.I.D. Principle

15

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Chapter 8. Spinal Rehabilitation Fundamentals (continued) d. Contraindications for Rehabilitation e. Phases of Rehabilitation (3 R’s)

2. Muscle Mechanics 3. Proprioception Fundamentals

a. Tools of the Trade 4. Concepts of Strengthening

a. Dynamic Movers and Stabilizers b. Aerobic Exercise c. 8 Principles to Rehabilitation d. Points to Consider

5. Protocols and Sets a. Abdominal Hollowing + Pelvic Tilt b. Dead Bug Progressions (on floor) c. Floor Bridge Progressions (on floor) d. Quadriped Progressions (on floor) e. Cervical Therapeutic Exercises f. Upper Back/Torso Exercises g. Posture and Proprioception h. Body Ball Therapeutic Exercises i. Dead Bug Progressions (on ball) j. Bridge Progressions (on ball) k. Quadriped Progressions (on ball)

Chapter 9. Professional Boundaries and Ethics 1. Introduction

a. Seven Principles b. Chiropractic Standards c. Keys to Communicating with Patients

2. Examination and Treatment Recommendations a. Examinations b. Exam Recommendation Checklist c. Should you use a Chaperone

3. Essential Responsibilities a. Who is responsible b. Consent c. Verbal and Non-verbal Communications d. Printed Material e. Medical Photography

4. Sexual Harassment a. Definitions of Sexual Harassment b. Two General Categories of Sexual Harassment c. Social Ethical Guidelines for Sexual Harassment d. Types of Harassment Behaviors e. Harassment from the Patient

10

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Chapter 9. Professional Boundaries and Ethics (continued) f. Sexual and Improper Relationships with Current/Former Patients g. The Law h. U.S. EEOC i. Sexual Behavior (Your Duty vs. Your Duty to Report)

Chapter 10. Emergency Procedures 1. Is Your Office Prepared?

a. First Aid Kit b. Automated External Defibrillator (AED)

2. Rescue Breathing, CPR, and Foreign Body Airway Obstruction a. Adult Rescue Breathing/CPR b. Foreign Body Airway Obstruction (Conscious Adult) c. Foreign Body Airway Obstruction (Unconscious Adult) d. Infant/ Child Rescue Breathing e. Infant/ Child CPR f. Foreign Body Airway Obstruction (Conscious Infant/Child) g. Foreign Body Airway Obstruction (Conscious Newborn to 1 year) h. Foreign Body Airway Obstruction (Unconscious Infant/Child)

3. Emergency Preparedness (Quick Reference Sheet)

5

Total Estimated Related Instruction Hours 162

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Radiological Related Technical Instruction

Glacier Valley Medical Education 91008 US Hwy 89, Grover, Wyoming, 83122

Email info@glaciermedicaled.com Phone 307-887-0419

Web Site http://www.glaciermedicaled.com Approximant Cost $379.00, Delivery On line

Radiological Related Instruction Outline Estimated

RTI Hours Section 1: Introduction to the Radiology Department

2

Section 2: Properties of X-rays and X-ray Physics OBJECTIVES: Examination the physics and properties of x-rays

• The discovery of x-rays • What are x-rays • Properties of x-rays • The structure of atoms and the Periodic table of the elements • Radiation sensitivity of body tissues

12

Section 3: Components of the X-ray Machine and X-ray Equipment OBJECTIVES: How x-rays are produced by an x-ray tube

• X-ray tube construction • Anode-heel effect • X-ray tube warm-up • Generator, rectifier, transformer, line voltage compensator, and operator's console • Manual timers and phototimers

12

Section 4: Radiation Protection for Health Care Workers OBJECTIVES: The outcomes of various interactions of x-rays with matter

• Inverse square law • Primary and secondary exposure • Protective shielding

8

Section 5: Minimizing Radiation Dose to Patients • Restricting the x-ray beam • X-ray beam filtration • Radiation protection for patients

8

Section 6: Monitoring Radiation Exposure • Units of radiation measurement • Types of radiation monitoring devices • Radiation monitoring programs • Maximum yearly and lifetime permissible occupational radiation exposure

8

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Section 7: Technical Factors of X-ray Production (kVp, mAs, time) • Technical factors of x-ray production: kVp, mAs, exposure time, and distance • Contrast: subject, image and radiographic • The inverse square law

16

Section 8: Technical Factors of X-ray Production (film, screens, grids) • Intensifying screens • Grids • Filtration and compensating filters • X-ray film • Factors which influence radiographic detail • Magnification and distortion of the radiographic image

16

Section 9: Processing x-ray film in the darkroom, archiving images, PACS and film-less networks

• Construction, properties, and handling of x-ray film • Film storage and handling • Darkroom safelights for film • Film fog • Automatic x-ray film processing and film transport • Silver recovery • Common automatic film processor problems • Processor maintenance • PACS and film-less radiology

10

Section 10: Malfunctions of X-ray Equipment, Troubleshooting • Radiographic equipment problems and trouble shooting • Improper technique selection • Common reasons why films have to be repeated

8

Section 11: Radiographic Contrast Agents • History of discovery and development of contrast agents used in x-ray • Terms related to radiographic contrast agents • Negative and positive contrast • Clinical uses of contrast • Adverse reactions to contrast

4

Section 12: Radiographic Contrast Reactions • Screening patients prior to contrast administration

Types of contrast reaction: Mild, Moderate, Severe, and Fatal

4

Section 13: Medical Emergencies in the Radiology Department • Basic terms related to medical emergencies • Common medical emergencies experienced in a healthcare facility

8

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Section 14: Infection Control • Infection and disease transmission • Asepsis and sterile technique • Standard precautions • Isolation • Transporting or performing examinations on infectious patients • Utilize Personal Protection Equipment (PPE) appropriately

8

Section 15: Confidentiality, Quality Patient Care, and Education • Providing quality patient care • Patient confidentiality • Aspects of care patients value most • Patient education • Patient assessment

8

Section 16: Professional and Legal Considerations in Radiology • Scope of practice • Duties of a radiologic technologist • Common causes of litigation against health care workers • Public law • Civil law • Patient identification

8

Section 18: Anatomy and Physiology 10 Section 19: Upper Lower Extremity Positioning 10 Section 20: Lower Extremity Positioning 10 Section 21: Chest Positioning 10 Section 22: Abdomen Positioning 10 Section 23: Spine Positioning 10 Section 24: Skull Positioning 10 Section 25: Gastrointestinal, Genitourinary and Fluoroscopy 10 Section 26: Radiographic Film Critique and Image Evaluation 10 Section 27: Tips on taking your state limited license examination and receiving your certificate of course completion

Total Estimated Related Instruction Hours 160 Notes: This course was designed with the assumption that the student taking the course has not worked in a radiology setting in the past. Although length of time to complete the course varies considerably according to each student’s background and study habits, we have listed the amount of time we suggest the average student spends in each section of the course so that a solid foundation of learning can be achieved. Some students complete the course in a fraction of the suggested time, while others take longer. The suggested reading times are included on the following course outline.

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The Radiology Study Guide course is divided into two main divisions: Academic curriculum and Clinical curriculum. Two main divisions sub-divided into 27 smaller sections, each with 10-20 pages of reading. 1. Academic Curriculum: 150 hours of reading. This includes the first 16 sections of the course including physics, equipment, radiation safety, technical factors, anatomy, etc. 2. Clinical Curriculum: 100 hours of reading and practice. This includes the final 11 sections of the course including positioning the patient and correctly performing the procedures. In some states, students are required to spend a certain number of clinical hands-on hours in a medical facility practicing and performing radiographic procedures as part of their state licensing requirements. You can check your state's requirements by using the "requirements" link at the bottom of this page). Note, the registered apprenticeship program increases the clinical to 200 hours to include the on the job learning. Some students are only interested in becoming licensed in one or two areas of practice, while others are interested in becoming licensed in all scopes of practice available. All students should read through each of the sections of the course even if they do not intend to become licensed in certain sections. This ensures a more fundamental background and will prove to be valuable. Suggested reading times are for students who intend to become licensed in that specific scope of practice.

First Aide for BLS Frontier Safety and Supply

550 E. Tudor Rd. Anchorage, Alaska 99503

http://www.alaskachiropracticsociety.com/events/EventDetails.aspx?id=779915&group Contact Alaska Chiropractic Society

Approximant Cost $75.00

First Aide Related Instruction Outline This class fulfills Chiropractic Physician requirements for cardiopulmonary resuscitation and BLS/AED training. The program develops basic first aid knowledge, skills, and the confidence to respond in CPR, AED, and Basic First Aid emergencies and is consistent with recommendations of the 2010 National First Aid Science Advisory Board and OSHA’s best practices. Completers receive a 2 year certification.

4

Total Related Instruction Hours 4