Download EI Clinic Manual - Midwestern University

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Transcript
MIDWESTERN UNIVERSITY
EYE INSTITUTE
CLINIC MANUAL
MIDWESTERN UNIVERSITY EYE INSTITUTE
19379 N. 59TH AVENUE,
GLENDALE, AZ 85308
623-537-6000
WWW.MWUCLINIC.COM
TABLE OF CONTENTS
Item
Page
Number
OVERVIEW OF MWU EYE INSTITUTE
Mission Statement, Vision and Goals of the Arizona College of Optometry
Patient Bill of Rights
Responsibilities as Patient or Guardian of the Patient
Policy on Dependents and Minors
Non-discrimination Policy
Medical Records Requests
Inmate Procedure
Health Insurance Portability and Accountability Act (HIPAA)
Mandatory Training
Organizational Chart with Definitions
Eye Institute Committees
Hours of Operation
4
5
5
5
6
6
6
7
8
9
12
14
GENERAL POLICIES AND PROCEDURES FOR FACULTY
Clinical Attending Faculty Responsibilities
Clinical Privileging
Clinical Attending Faculty Absence Policy
On-Call Policy
15
16
18
19
OVERVIEW OF THE CLINICAL ROTATION PROGRAM FOR OPTOMETRY STUDENTS
Rotation Management System (RMS)
Meditrek
Key Personnel, Offices and Support
Policies and Procedures for Student Clinicians
Patient Management and Protocols
Professional and Appropriate Communication and Courtesies
General Program Guidelines and Policies
Clinical Rotation Policies
Clinical Rotation Requirements
External Rotation Site Selection
O.D.-3 Rotation Specific Information
O.D.-4 Rotation Specific Information
Overview of Rotation Requirements for Third and Fourth year Students
20
20
20
22
25
25
27
38
45
47
48
48
49
SAFETY PROCEDURES FOR THE EYE INSTITUTE
MWU Emergency Response Plan
MWU Emergency Response Team
Eye Institute Emergency Response Plan
Protocol for AED and CPR
Location of Emergency/Courtesy Phones
General Disaster Procedures
Universal Precautions and Exposure Control Plan
52
52
52
52
53
53
56
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 2 of 95
Housekeeping, Decontamination and Spill Cleanup
Clinical Disinfection Procedures
Clinical Precautions and Procedures
Laser Safety Sheets
Material Safety Data Sheets
63
64
65
66
66
SAFETY PROCEDURES FOR EYE INSTITUTE PATIENT CARE
Adverse Drug Reactions
Abuse or Neglect Reporting
Be Safe/Be Smart Crime Prevention
Imaging Orders
Laboratory Testing
Microbiology Cultures
Ocular Emergencies
Pharmaceutical Samples Policy
Prescribing Controlled Non-narcotic Medications
Prescribing Narcotic Medications
Sterilization and Disinfections Procedures
Therapeutic Drug Policy
67
67
69
70
70
70
70
70
70
70
70
70
APPENDICES
APPENDIX I - PATIENT CARE POLICIES
Clinical Services and Referrals
Release of Prescription Policy
Optometric Prescription Standards
Letter Writing Guidelines
Patient Complaint Procedure
72
APPENDIX II - MWU CLINIC POLICIES
76
APPENDIX III- QUALITY ASSESSMENT PROGRAM
78
APPENDIX IV- COURSES DELIVERED IN-PART OR WHOLE WITHIN THE EYE INSTITUTE
Clinical Services I-III
Ophthalmic Optics/Optical
Ocular Prosthetic
Electro diagnostics
79
APPENDIX V - INCIDENT REPORT FORM
87
APPENDIX VI - INTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM
88
APPENDIX VII - EXTERNAL REQUEST FOR CLINICAL ROTATION ABSENCE FORM
89
APPENDIX VIII – OPTO 1800-1830 CLINICAL SERVICES XI- XIV MIDTERM AND FINAL 90
GRADING FORM
APPENDIX IX - PRECEPTOR AND SITE EVALUATION
94
APPENDIX X – PATIENT LOG
95
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 3 of 95
OVERVIEW OF MWU EYE INSTITUTE
Mission Statement
Arizona College of Optometry
The mission of Midwestern University Arizona College of Optometry (AZCOPT) is to educate
future optometrists and residents in an inter-professional healthcare environment. The College
fosters professional attitudes and behaviors that encourage lifelong learning and scholarship to
serve the needs of the public and improve the health and well-being of society.
The Goals of the Arizona College of Optometry are listed below.










Provide broad and innovative educational opportunities in the basic, visual, and clinical
sciences.
Plan and develop a diversity of clinical experiences to allow our students to enter the
practice of optometry.
Support and nurture an environment of intellectual inquiry and activity by students,
residents, and faculty.
Promote inter-professional educational programming to develop students’ appreciation of
other health care professions.
Ensure that students have a strong basic and vision science foundation.
Promote student involvement in community service.
Develop a high quality residency program.
Establish an Eye Institute that serves the eye/vision care needs of the community.
Provide lifelong learning activities and support services to the optometric profession and
the public.
Maintain the financial viability of the College.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 4 of 95
Patient Bill of Rights
The Midwestern University Clinics are committed to providing quality care and service for our
patients. As a health sciences university, we also provide training for future healthcare
professionals who are supervised by our faculty. As a partner in this educational process, you
have the following rights:
1. You have a right to an appointment with your healthcare provider in a timely manner.
2. You have a right to considerate, respectful care from your doctors, health plan
representatives, and other healthcare providers that does not discriminate against you.
3. You have a right to accurate and easily understood information about your health plan,
healthcare professionals, and healthcare facilities.
4. You have a right to expect appropriate infection and sterilization controls.
5. You have a right to an explanation of the prescribed treatment, treatment alternative, the
option to refuse treatment, the risk of no treatment, and expected outcomes of these
treatments, and to be told, in language you can understand, the advantages and disadvantages
of each.
6. You have the right to know your treatment options and to take part in decisions about your
care. Parents, guardians, family members, or others whom you select can represent you if you
cannot make your own decisions.
7. You have a right to continuity and completion of treatment.
8. You have a right to emergency, incremental, and total patient care.
9. You have a right to treatment that meets the standard of care for the profession.
10. You have the right to talk privately with healthcare providers and to have your healthcare
information protected. You also have the right to ask that your doctor amend your record if it
is not accurate, relevant, or complete.
11. You have the right to a fair, fast, and objective review of any complaint you have against
your health plan or healthcare provider. This includes complaints about waiting times,
operating hours, the actions of healthcare personnel, and the adequacy of healthcare facilities.
Along with your rights, there are patient expectations and responsibilities.
Responsibilities as the Patient or Guardian of the Patient
1. You have the responsibility to provide accurate and complete information about your or your
child's medical history.
2. You have the responsibility to question treatment or instructions you do not understand.
3. You have the responsibility to keep scheduled appointments and provide at least 48 hours of
notice if you need to cancel an appointment.
4. You have the responsibility to provide information about payment to the MWU Eye Institute
to ensure that financial obligations are met.
Policy on Dependents and Minors
All patients under the age of 18 years are considered minors. All developmentally challenged
patients who do not have a declaration of independence are to be considered dependents. All
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 5 of 95
minors and dependents will be examined only when a parent, guardian, or caretaker is present at
the appointment.
At the time the appointment is made, staff will notify the family, guardian, or caretaker that they
must accompany the patient to the appointment.
Non-discrimination Policy
No patient will be denied treatment based on race, color, religion, national origin, gender, sexual
orientation, age, marital status, disability, or public assistance status.
Medical Records Requests
All medical records requests require a Release of Medical Records form that is signed, dated and
witnessed. The Release of Medical Records form is available at the Reception Desk of the MWU
Eye Institute. Once the form is completed and submitted, it will remain on file in the patient’s
medical record.
All medical records requests should be forwarded to the clinic referral coordinator or the clinic
manager. The clinic referral coordinator or clinic manager will take the responsibility to deliver
the records to the patient and document their action into the patient chart.
When face to face delivery is requested, proper identification is to be presented and documented
in the patient’s chart prior to exchange of the medical record envelope. When medical records
are handed to, mailed, faxed or otherwise electronically delivered, the records should be sealed
in an envelope with the patient’s full name and address with the following statement visible on
the OUTSIDE of the envelope:
“The information contained in this envelope and any accompanying documents is
intended for the sole use of the recipient to whom it is addressed, and may contain
information that is privileged, confidential, proprietary to sender, and prohibited from
disclosure under applicable law. If you are not the intended recipient, or authorized to
receive this on behalf of the recipient, you are hereby notified that any review, use,
disclosure, copying, or distribution is prohibited. If you are not the intended recipient(s)
or have received this communication in error, please contact the sender by e-mail or
mail and destroy all copies of the original message or paperwork. Thank you.”
This should then be sealed in a larger envelope and mailed to the patient’s address of record.
Inmate Procedure
No more than one inmate patient should be scheduled for a service at a time. Inmate patients
should be escorted by correctional institution guards/law enforcement at all times while on
University property. Inmate patients should be seen immediately upon arrival and escorted to
the patient care area of the appropriate service
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 6 of 95
PROCEDURE:
MWU Security personnel will be informed at least 24 hours in advance of an inmate patient’s
scheduled appointment.
Correctional institution guards/law enforcement should be instructed to park in the parking
garage and await escort by a member of MWU security.
The inmate patient should not be taken through the main entrance upon arrival or departure if
possible. The inmate patient should be escorted directly to the appropriate treatment area.
The correctional institute guards/law enforcement must remain in the examination area
throughout the examination. No MWU Eye Institute faculty, staff, or student(s) may be alone, in
the examination room or otherwise, with an inmate patient without a correctional institution
guard/law enforcement present. MWU Eye Institute faculty, staff, and students working with
inmate patients should keep the door open when possible and should position themselves so that
they can quickly leave the room if the patient becomes aggressive, e.g., do not position the
patient between the faculty, staff, or student and the door.
If an inmate patient becomes aggressive, the faculty, staff, or student should immediately leave
the room and notify MWU security.
Upon completion of eye services, the inmate will be escorted through the side doors to return to
the awaiting transportation vehicle.
Should frame selection be required, the optician will make an initial assessment of the inmate’s
needs, select several options and present to the inmate in the examination area. Completion of
optical services will be done in the examination room.
All billing arrangements will be made prior to scheduling the appointment for the inmate with
the Assistant Manager of Finance at the MWU Eye Institute. The Assistant Manager will then
obtain authorizations and billing information to be entered into Patient Management System
along with the necessary demographics. Charges for services will be based on what is usual and
customary. The front desk will then make the appointment arrangements and forward necessary
paperwork to be completed prior to the appointment to the appropriate authority. Paperwork
should be completed and returned prior to the patient being seen, and scanned into the patient’s
record..
A routing sheet will be completed by the attending optometrist and returned to the Assistant
Manager of Finance for posting.
Health Insurance Portability and Accountability Act (HIPAA)
The privacy of patients’ medical information is imperative in all modes of practice. All faculty
and students will be compliant with the Health Insurance Portability and Accountability Act
(HIPAA). Upon check-in as a patient in the MWU Eye Institute, a patient is asked to read and
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 7 of 95
sign the following MWU Clinic forms: Patient Authorization, Assignment and
Acknowledgement Form (HIPAA Form), Student Acknowledgement Form (student doctor
acknowledgement), and Patient Information Sheet (includes personal and insurance information).
They are offered a copy of the HIPAA policy to take with them. All signed forms are scanned
into the medical record.
The release of information policy will follow HIPAA guidelines in that no information will be
released without a written request from the patient. When release of information is requested by
a patient, the attending doctor or faculty of the day must review the printed record for
completeness before it is released to a patient or doctor.
When a patient presents with a letter or form that requires inclusion of a patient’s medical
information (e.g. state department of motor vehicles, insurance claims, etc), the attending doctor
or faculty of the day will follow the same release of information policy. This is specified in the
MWU policy on patient requests to inspect and obtain a copy of their medical records, which is
found in the appendix of this manual.
A minimum necessary use of protected health information policy is in place to accommodate a
patient’s request for special privacy protection of their Protected Health Information (PHI). This
is outlined in the standard MWU policy found in the appendix of this manual.
Mandatory Training
Mandatory training for faculty and staff will take place annually. These online courses are
accessed through Law Room by arrangement through MWU Human Resources.
These courses include:

Universal precautions for blood borne pathogens

OSHA updates related to clinical care and safety

Health insurance portability and accountability act as it relates to patient privacy and
security

Family Educational Rights and Privacy Act
Mandatory CPR training will be offered annually for students and faculty. Cardiopulmonary
resuscitation is offered within the course OPTO 1700 Physical Medicine. The successful
completion of this course is necessary to work in the MWU Eye Institute. It is the responsibility
of the individual to assure that they are in compliance with the mandatory training requirements.
If a faculty or staff is identified to be out of compliance, they will be given a written warning to
correct the deficiency within a two week period. Non-compliance with this warning will result in
ineligibility to work in the MWU Eye Institute with whatever penalty that entails.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 8 of 95
Organizational Chart
The clinical faculty of the MWU Eye Institute will hold dual appointments in the Arizona
College of Optometry and will be evaluated in accordance with the Faculty Handbook and MWU
Human Resources guidelines. The clinic staff will be evaluated annually using standardized
evaluation forms by the Clinic Manager in accordance with MWU Human Resources guidelines.
MIDWESTERN UNIVERSITY
ARIZONA COLLEGE OF OPTOMETRY
EYE INSTITUTE
ORGANIZATIONAL CHART
AND
Descriptions for the positions shown in Figure above include:
Assistant Dean of Clinical Affairs
The Assistant Dean of Clinical Affairs oversees the patient care and teaching activities of the
MWU Eye Institute. As such, the Assistant Dean of Clinical Affairs develops clinic policies and
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 9 of 95
guidelines appropriate for MWU Eye Institute. All such policies are then forwarded to the
MWU Eye Institute Operations Committee. If approved by the committee, policies are then
forwarded to the MWU Clinic Management Oversight Committee for approval, and then on to
the University President for final approval.
The Assistant Dean of Clinical Affairs with the assistance of the Assistant Director, Clinical
Rotations and the Clinical Education Coordinator, develops and monitors the externship and
community outreach program of the college. This includes setting criteria for preceptors and
externship sites, evaluation and training of preceptors, and coordinating contract agreements. The
Assistant Dean of Clinical Affairs assumes overall responsibility to ensure that students have
ample opportunities to gain the clinical competencies as determined by the faculty. Together
they coordinate the receipt, calculation and posting of student grades for internal (MWU Eye
Institute) and external rotations. The Assistant Dean of Clinical Affairs works with course
directors for the OPTO 1700 and OPTO 1800 series as well as the Assistant Director, Clinical
Rotations to identify students with unsatisfactory performance and forwards those grades to the
Student Promotion and Graduation Committee for review and action
The Assistant Dean of Clinical Affairs monitors, with the assistance of the Clinic Manager, the
operations of the dispensary, ordering of supplies, maintenance of equipment and performance of
the opticians and ophthalmic technicians at the MWU Eye Institute.
The Assistant Dean of Clinical Affairs assists the Associate Dean of Academic Affairs to
develop and determine the faculty clinical workload. The Assistant Dean of Clinical Affairs
works with the Associate Dean of Academic Affairs on didactic course and clinical rotation
teaching assignments of faculty, creation of annual faculty development plans, and annual
performance evaluations for the faculty.
Additionally, the Assistant Dean of Clinical Affairs works with the Residency Program Advisory
Committee to plan and develop residency programs associated with MWU Arizona College of
Optometry.
Assistant Director, Clinic Operations
The Assistant Director, Clinic Operations oversees the daily clinic operations of the MWU Eye
Institute. As such, The Assistant Director, Clinic Operations works with the Clinic Manager to:
coordinate and implement the daily clinical schedule, including patient, student and clinical
faculty schedules, develop and implement staff development and training programs, coordinate
maintenance and inventory control of all clinic equipment, manage the on call service and handle
patient care or service issues as needed. The Assistant Director, Clinic Operations collaborates
with the Assistant Dean of Clinical Affairs to establish and maintain new clinical services, direct
marketing strategies and enhance quality and efficiency of patient care.
Assistant Director, Clinical Rotations
The Assistant Director, Clinical Rotations sets criteria for preceptors and external rotation sites,
evaluation and development of preceptors, negotiating contract agreements, and resolving
student and preceptor performance issues. The Assistant Director, Clinical Rotations serves as
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 10 of 95
the immediate liaison for all external preceptors and student externs. The Assistant Director,
Clinical Rotations works to ensure that students have ample high quality opportunities to gain
clinical competencies as determined by the faculty.
Clinic Manager
This position reports to the Assistant Dean of Clinical Affairs and supervises and monitors the
activities of the dispensary and back office staff. The Clinic Manager schedules and monitors the
staffing of the optometry clinic to assure efficient clinic operations. The Clinic Manager
collaborates with the Assistant Clinical Patient Accounts Manager and the Patients Account
Manager to oversee patient registration and collection of fees. The Clinic Manager supports
clinic operations by working closely with the Assistant Dean of Clinical Affairs and the Assistant
Director, Clinic Operations to organize staff meetings. The Clinic Manager is familiar with
Compulink® clinical management and electronic medical record system; is able to prepare
reports and statistics on student activities related to practice management; oversees patient flow;
and resolves patient issues associated with appointments, fees, and other operational issues. This
position requires knowledge and compliance with OSHA and HIPAA regulations; monitoring of
clinical and patient safety equipment; and checking expiration dates on all materials, supplies,
and equipment. The Clinic Manager assists with monitoring compliance with University policies
and procedures.
Clinical Education Coordinator
The Clinical Education Coordinator works closely with the Assistant Director, Clinical Rotations
and the Assistant Dean of Clinical Affairs to assist in the coordination and development of the
community based clinical rotations for the third year students and also the external rotation sites
for the fourth year students. This individual is responsible for creating and maintaining quarterly
clinic schedules for third and fourth year students in both the MWU Eye Institute as well as on
external rotations. In addition, this individual maintains the clerkship portion of the MWU Eye
Institute Clinic Manual and the External Rotation Manual; processing evaluations of students and
preceptors for review by the Clinical Course Directors and the Assistant Dean of Clinical
Affairs; and training students and preceptors on the Rotation Management System and Meditrek
software.
Lead Ophthalmic Technician
The Lead Ophthalmic Technician is responsible for the maintenance, storage, and basic
operation of all routine and specialized testing instrumentation for the clinical floor of the MWU
Eye Institute. The Lead Ophthalmic Technician assists the faculty and students in performing
uniform administration of specialized testing. The technician is responsible for transferring test
results to the attending optometrist. This individual facilitates quality learning experiences for
students during their clinical rotations in the MWU Eye Institute, and therefore demonstrates
characteristics of sound patient management and ethical and professional behavior in optometric
practice. The lead ophthalmic technician has responsibility for the development of educational
activities in the attainment of accurate specialty test administration and equipment maintenance.
This position reports to the Clinic Manager.
Ophthalmic Technician
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 11 of 95
The Ophthalmic Technician is responsible for basic operation of all routine and specialized
testing instrumentation for the clinical floor of the MWU Eye Institute. The Ophthalmic
Technician assists the faculty and students in performing uniform administration of specialized
testing. The technician is responsible for transferring test results to the attending optometrist.
This individual facilitates quality learning experiences for the students during their clinical
rotations in the MWU Eye Institute, and therefore must demonstrate characteristics of sound
patient management and ethical and professional behavior in optometric practice. The
Ophthalmic Technician is responsible for ordering and cataloging the contact lenses as
prescribed by the attending optometrist. This position reports to the Clinic Manager.
Lead Optician
The American Board of Opticianry-certified optician within the MWU Eye Institute is
responsible for frame inventory, frame board management, meeting with frame representatives,
tracking product sales, merchandising, theft prevention, marketing and direct patient care. The
Lead Optician fulfills an educational role by coordinating with the ophthalmic optics and
practice management educator in the teaching and application of optometric practice
development principles, such as the selection and marketing of ophthalmic products, patient
education, and service. This position reports to the Clinic Manager.
Opticians
The Opticians are responsible for frame inventory, frame board management, meeting with
frame representatives, tracking product sales, merchandising, theft prevention, and direct patient
care. The Optician will additionally fulfill an educational role by coordinating with the
ophthalmic optics and practice development principles, such as the selection and marketing of
ophthalmic products, patient education, and service. This position reports to the Clinic Manager.
Clinical Attending Optometrist (Faculty)
Clinical Attending Optometrist is a clinical faculty member or an adjunct clinical instructor. The
clinical attending optometrist is responsible for overseeing student clinicians. The specific duties
and responsibilities are outlined in the General Policies and Procedures section under Clinical
Attending Optometrist responsibilities.
Eye Institute Committees
a.
Eye Institute Policy And Procedure Committee
Purpose: To gather input from faculty and staff on various aspects of clinic operations, including
policy and procedure.
Description: Conducts patient flow analyses and provides recommendations to the Assistant
Dean of Clinical Affairs to enhance efficient patient flow; monitors all marketing initiatives to
ensure that they are compliant with federal, state, and university policies, procedures and
regulations; ensures that information technology requirements are met and data storage is
adequate; ensures that specialized equipment requirements are met; reviews and advises on
policies and procedures within the Eye Institute; ensures that as new services are developed in
the MWU Eye Institute, that appropriate policies and procedures are drafted. The committee
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 12 of 95
should provide all draft policies and procedures to the Eye Institute Operations Committee and
MWU Clinic Management Oversight Committee for final approval.
Membership: The committee is composed of at least four (4) members. At least one (1) member
will be a representative for information technology. The Assistant Dean of Clinical Affairs
serves in an ex-officio capacity to advise the committee.
Chairperson: The chairperson is appointed by the Dean of the Arizona College of Optometry
from the committee membership.
b.
Eye Institute Best Practices Committee
Purpose: To ensure the highest standards of care are followed in the MWU Eye Institute
regarding patient care, faculty privileging/credentialing, HIPAA compliance, and chart reviews.
The Best Practices Committee has been meeting regularly since the start of the Eye Institute, but
requires MWU Faculty Senate approval to become a MWU Faculty Committee.
Description: Develops evidence-based standards of care; establishes privileging levels for the
Eye Institute; reviews requests for privileges for individual faculty and provides
recommendations on those requests to the AZCOPT Credentialing and Privileging Committee;
ensures clinic compliance with HIPPA regulations, cardiac life support, and infection control
policies; conducts chart reviews for quality assurance purposes, and reviews and approves of all
clinic forms. This Committee provides regular reports of its chart reviews to the Eye Institute
Operations Committee. For any deficiencies identified by its audit, the Committee proposes a
correction plan to the Eye Institute Operations Committee.
Membership: The committee is composed of at least three (3) faculty members, the Assistant
Manager of Patient Accounts, and a Patient Account Representative. The Assistant Dean of
Clinical Affairs serves in an ex-officio capacity to advise the committee.
Chairperson: The chairperson is appointed by the Dean of the Arizona College of Optometry
from the committee membership.
c.
Credentialing And Privileging Committee
Purpose: To approve privileging level and credentialing of Eye Institute faculty.
Description: Ensures that faculty is appropriately credentialed and privileged; approves
privileges for individual faculty.
Membership: The committee is composed of all AZCOPT Administration members.
Chairperson: The Dean serves as the chairperson for this committee.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 13 of 95
Hours of Operation
The MWU Eye Institute is open for patient care from 8:00 a.m. to 5:00 p.m., Monday,
Wednesday, and Friday, and 8:00 a.m. to 7:00 p.m. on Tuesday and Thursday, excluding
holidays. Patient check-in begins at 7:30 a.m.
After-hour emergencies are handled by the eye care practitioner on call. The call schedule is
approved quarterly by the Clinic Manager.
Approved MWU holidays include:
 Independence Day-July 4, 2014
 Labor Day-September 1, 2014
 Thanksgiving Holidays-November 27-28, 2014
 Christmas Eve-December 24, 2014
 Christmas Holidays-December 25-26, 2014
 New Year’s Eve-December 31, 2014
 New Year’s Day-January 1, 2015
 Martin Luther King, Jr. Day-January 19, 2015
 Memorial Day- May 15, 2015
Emergency closing of the MWU Eye Institute is restricted to a catastrophic event, as determined
by the University President. The faculty and staff that are required to report to work in the case
of an unforeseen event, include the Assistant Dean of Clinical Affairs, the Clinic Manager and
the Assistant Manager of Patient Accounts.
The use of the MWU Eye Institute during non-clinic hours by students requires written consent
of the Assistant Dean of Clinical Affairs. The written consent should include the task to be
completed, the date and expected time allotment and expected location of the task. A clinical
faculty advisor must be present to supervise students during non-clinic hours. Written requests
should be received by the Assistant Dean of Clinical Affairs a minimum of one week prior to the
event.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 14 of 95
GENERAL POLICIES AND PROCEDURES FOR FACULTY
Clinical Attending Faculty Responsibilities
The Clinical Attending Faculty (Attending Optometrist, Clinical Preceptor) must ensure that
their licensure, credentialing, and malpractice insurance policy is up to date and on file with the
Assistant Dean of Clinical Affairs. The Clinical Attending Faculty is responsible both legally
and ethically for the care of the patient. Additionally, at each patient encounter the Clinical
Attending Faculty ensures:






Performance and recording of all indicated examination procedures
Comprehension and interpretation of examination results and their implications
Determination of diagnosis, treatment and management, inclusive of further testing,
referral and/or correspondence
Completion of electronic medical record inclusive of examination procedures,
disposition, plan and billing
Effective patient communication
Employment of optometric best practices
Day to day activities of the Clinical Attending Faculty will include but not be limited to:















Assignment of student clinicians to their patients
Demonstration of clinical skills, inclusive of a complete examination sequence in their
area of expertise
Observation of student clinicians with constructive assistance to improve patient care
Consultation on patient care
Monitoring and reviewing each patient care encounter
Guiding student clinicians to a complete an accurate patient care encounter inclusive of
diagnosis, treatment and management
Assisting in completion of the electronic medical record including disposition, plan, final
review, referral, dispensing, billing and signatures
Performing complete ocular evaluation and conducting case disposition with each patient
in concurrence with established standard of care guidelines
Ensuring continuity of care for each patient
Ensuring referral letters and/or outside forms are completed and sent to appropriate
source
Evaluating the performance of the student clinician on patient encounters with written
and/or verbal feedback
Identifying any student clinician who may need remediation as soon as possible
Providing patient care when students are absent
Work willingly with all clinical faculty, staff and students to solve challenges
Making use of effective clinical teaching skills and demonstrating the elements of
effective clinical teaching
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 15 of 95








Reading recommended support materials as identified by the Education Committee and
the Assistant Dean of Clinical Affairs. Making themselves available to student clinicians
Arriving on time
Dressing in appropriate professional clinical attire
Notifying the Assistant Dean of Clinical Affairs, the Clinic Manager and student
clinicians of any planned and approved absences
Adhering to the clinical fee schedule
Complying with Clinical Faculty Privileging and Credentialing
Attending MWU Eye Institute meetings
Completing assigned duties
Clinic Privileging
An application for credentialing will be completed by each faculty member who is assigned to
work in the MWU Eye Institute. The application will include documentation from primary
sources to support all state and national license(s), provider numbers, insurance, board
certification and DEA number. The credentialing process may take up to three months.
Privileging will be granted to faculty members at levels that correspond to the faculty member’s
credentials, appropriate patient care requirements, and specialty clinic demands. The privileging
levels are described below along with the form that must be completed by the faculty member
requesting privileges.
Approved privileges of faculty members will be on file in the MWU Eye Institute’s
administrative office upon approval by the Assistant Dean of Clinical Affairs.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 16 of 95
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 17 of 95
Procedure for Privilege Request Form
For expanded procedures that clinical faculty would like to perform in the MWU Eye Institute,
they must submit a completed procedure privilege request to the MWU Eye Institute Best
Practices Committee for review and approval. Once the Best Practices Committee votes to
approve the request for privileges, the application and the Best Practices Committee’s decision
must be forwarded to the Credentialing and Privileging Committee for final approval. The
approval process must be completed before a clinical faculty can perform the specified
procedure.
Clinical Attending Faculty Absence Policy
When a Clinical Attending Faculty must be absent from their clinical responsibilities, it is his/her
responsibility to arrange for coverage of their assigned duties. Notification must be made to the
Assistant Dean of Clinical Affairs, Clinic Manager, and the student clinicians. Notification for
planned absences should be made no later than two months in advance so that clinic schedules
can be altered, if needed.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 18 of 95
On Call Policy
On Call schedules will be determined by the Clinic Manager under the direction of the Assistant
Director, Clinic Operations. On Call schedules will be posted online as well as distributed via
electronic mail. Each clinical faculty member is expected to cover after hours, weekends, and
holidays as dictated by the call schedule. Schedule changes will require notification of the Clinic
Manager and the Assistant Director, Clinic Operations. The On-Call service used by the faculty
to contact the patient has this number: 623/537-6000.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 19 of 95
OVERVIEW OF THE CLINICAL ROTATION PROGRAM
FOR OPTOMETRY STUDENTS
The clinical experience for students in the Arizona College of Optometry program begins in the
first professional year with clinical observations and progresses to more hands-on involvement as
the students learn clinical skills and procedures. Starting in the summer quarter of the third
professional year the student clinicians will be scheduled weekly in the MWU Eye Institute to
the primary care service to perform comprehensive eye care and contact lens examinations on
patients under the supervision of AZCOPT Clinical Faculty. These experiences will continue and
expand to the specialty services for each of the 4 quarters of the third year rotations within the
MWU Eye Institute. By the end of the third professional year the student clinicians will be
eligible to see patients in most of the specialty services of the MWU Eye Institute and its
affiliated clinical sites. During the fourth professional year the student clinicians may be assigned
to external rotation sites throughout the nation during the quarterly rotation periods. The
information included in this manual will primarily refer to the MWU Eye Institute clinical
experience. For comprehensive external rotation policies and procedures refer to the AZCOPT
External Rotation Manual.
Rotation Management System (RMS)
RMS is a Web-based rotation information system that houses AZCOPT student information and
documents necessary for external clinical rotation assignments. Additionally, RMS is utilized to
assist in the external rotation assignments process by providing information on preceptors and
rotation sites and calculating rotation assignment requirements along with student preferences.
Meditrek
Meditrek is a Web-based medical education management and administration tool. Meditrek
houses all of the student, preceptor, and site evaluations, as well as third and fourth year student
patient logs.
Key Personnel, Offices, and Support
1. Preceptors
A preceptor is a licensed health care provider who works directly with students in the
provision of health care services to patients. The preceptor is a teacher, mentor,
supervisor, role model, evaluator and counselor. It is the preceptor’s responsibility to
help students prepare themselves for effective and successful provision of optometric
services. The internal preceptor is commonly an AZCOPT faculty, either full time or
adjunct, that is scheduled to supervise the student clinician in the MWU Eye Institute or
affiliated clinical site. The course director of the clinical courses within the MWU Eye
Institute is the point of contact for MWU Eye Institute faculty preceptors. The external
rotation preceptor is a health care provider affiliated with AZCOPT through the external
rotation program, and is responsible for the evaluation of optometry students at their
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 20 of 95
rotation site. The external rotation preceptor is appointed as an adjunct faculty member
of AZCOPT. The Assistant Director of Clinical Rotations is the point of contact for the
external rotation preceptor.
Preceptor supervision and mentoring are essential components of a successful rotation
experience, and are further described below.
a. Professional Supervision by Preceptor
Professional supervision, as it relates to assigned optometry students, means (at a
minimum) that in no case shall a patient receive services or be treated based solely on
a student’s evaluation where a preceptor has not agreed to the findings, the
conclusions and the plan. The College does not intend that professional supervision
requires direct physical observation of all student clinical activity, however, students
cannot be required or allowed to provide professional services at any time when a
preceptor is not on the premises and not aware of the student activity.
b. Professional Mentoring by Preceptor
Professional mentoring includes many types of teaching activities including coaching
on technique, case analysis, patient communication, strategies for differential
diagnosis, role modeling of proper professional demeanor; making recommendations
for study or practice; providing evaluation feedback, career counseling and other
activities. In this way, the preceptor serves as a valuable role model for optometry
students as the latter gain confidence and expertise in their clinical skills and
decision-making.
2. Assistant Dean of Clinical Affairs
The AZCOPT Assistant Dean of Clinical Affairs, with the assistance of the AZCOPT
Assistant Director, Clinical Rotations and the Clinical Education Coordinator, develops
and monitors the internal and external clinical educational and community outreach
program of the college. This includes setting criteria for preceptors and external rotation
sites, evaluation and development of preceptors, negotiating contract agreements, and
resolving student and preceptor performance issues. The Assistant Dean of Clinical
Affairs assumes overall responsibility to ensure that during the clinical experiential
component, students have ample high quality opportunities to gain clinical competencies
as determined by the faculty. The Assistant Dean of Clinical Affairs, Dr. Joshua Baker
can be contacted by phone 623-806-7254, or e-mail [email protected]
3. Assistant Director, Clinical Rotation
The Assistant Director, Clinical Rotations sets criteria for preceptors and external rotation
sites, evaluation and development of preceptors, negotiating contract agreements, and
resolving student and preceptor performance issues. The Assistant Director, Clinical
Rotations serves as the immediate liaison for all external preceptors and student externs.
The Assistant Director, Clinical Rotations works to ensure that students have ample high
quality opportunities to gain clinical competencies as determined by the faculty. The
Assistant Director, Clinical Rotations, Dr. Alicia Feis can be contacted by phone 623806-7268, or e-mail [email protected]
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 21 of 95
4. Assistant Director, Clinic Operations
The Assistant Director, Clinic Operations oversees the daily clinic operations of the
MWU Eye Institute. As such, The Assistant Director, Clinic Operations works with the
Clinic Manager to: coordinate and implement the daily clinical schedule, including
patient, student and clinical faculty schedules, develop and implement staff development
and training programs, coordinate maintenance and inventory control of all clinic
equipment, manage the on call service and handle patient care or service issues as
needed. The Assistant Director, Clinic Operations collaborates with the Assistant Dean
of Clinical Affairs to establish and maintain new clinical services, direct marketing
strategies and enhance quality and efficiency of patient care. The Assistant Director,
Clinic Operations can be contacted by phone 623-806-7254.
5. Clinical Education Coordinator
The Clinical Education Coordinator will work closely with the Assistant Director,
Clinical rotations and the Assistant Dean of Clinical Affairs to assist in the coordination
and development of the community based clinical rotations for the third year students and
also the external rotation sites for the fourth year students. This individual is responsible
for creating and maintaining quarterly clinic schedules for third and fourth year students
in both the Midwestern University Eye Institute as well as on external rotations. In
addition, this individual will be responsible for being the immediate liaison for external
preceptors and students, maintaining the clerkship portion of the MWU Eye Institute
Clinic Manual and the External Rotation manual, processing evaluations of students and
preceptors for review by the Clinical Course Directors and the Assistant Dean of Clinical
Affairs; and training students and preceptors on the Rotation Management System and
Meditrek software. The Clinical Education Coordinator, Mrs. Lori Klein, can be
contacted by phone 623-806-7243.
Policies and Procedures for Student Clinicians
Standards of care and behavior must to be observed by all optometric student clinicians within
the Eye Institute or at any affiliated clinical sites. These standards are not exclusive to the MWU
Eye Institute but are held as standards we all must honor as optometrists.
Code of Ethics for Optometrists1
It shall be the ideal, resolve, and duty of all optometrists:






TO KEEP their patient’s eye, vision, and general health paramount at all times;
TO RESPECT the rights and dignity of patients regarding their health care decisions;
TO ADVISE their patients whenever consultation with, or referral to another optometrist
or other health professional is appropriate;
TO ENSURE confidentiality and privacy of patients’ protected health and other personal
information;
TO STRIVE to ensure all persons have access to eye, vision, and general health care;
TO ADVANCE their professional knowledge and proficiency to maintain and expand
competence to benefit their patients;
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 22 of 95




TO MAINTAIN their practices in accordance with professional health care standards;
TO PROMOTE ethical and cordial relationships with all members of the health care
community;
TO RECOGNIZE their obligation to protect health and welfare of society; and
TO CONDUCT themselves as exemplary citizens and professionals with honesty,
integrity, fairness, kindness, and compassion
1
Adopted by the House of Delegates as: Substantive Motion M-1944-1, June 1944; Modified
June 2005; Repealed June 2007 Modified and Adopted as Resolution #1969, June 2007
http://www.aoa.org/about-the-aoa/ethics-and-values/code-of-ethics?sso=y (accessed 6/19/2014)
The Optometric Oath2
With full deliberation I freely and solemnly pledge that: I will practice the art and science of
optometry faithfully and conscientiously, and to the fullest scope of my competence. I will
uphold and honorably promote by example and action the highest standards, ethics and ideals of
my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted
me.
I will provide professional care for those who seek my services, with concern, with compassion
and with due regard for their human rights and dignity.
I will place the treatment of those who seek my care above personal gain and strive to see that
none shall lack for proper care.
I will hold as privileged and inviolable all information entrusted to me in confidence by my
patients.
I will advise my patients fully and honestly of all which may serve to restore, maintain or
enhance their vision and general health.
I will strive continuously to broaden my knowledge and skills so that my patients may benefit
from all new and efficacious means to enhance the care of human vision.
I will share information cordially and unselfishly with my fellow optometrists and other
professionals for the benefit of patients and the advancement of human knowledge and welfare. I
will do my utmost to serve my community, my country and humankind as a citizen as well as an
optometrist.
I hereby commit myself to be steadfast in the performance of this my solemn oath and
obligation.
2Written
by Dr. Richard Hopping
Adopted by the American Optometric Association House of Delegates, June 1986
http://www.aoa.org/about-the-aoa/ethics-and-values/the-optometric-oath?sso=y
6/19/2014
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 23 of 95
Professionalism
The demonstration of professionalism is critical to the success of a healthcare professional. The
development of the values and attitudes that are required of a professional occurs over a period
of time and must begin early in a student’s education. In this way, professional behavior
becomes an integral part of an individual. Professionalism is demonstrated by the student who:
 Uses appropriate verbal and non-verbal communication
 Is punctual
 Is reliable, dependable and accountable for one’s actions
 Behaves in an ethical manner
 Produces quality work
 Accepts constructive criticism and modifies behavior, if necessary
 Is cooperative, i.e. non-argumentative; willing and helpful
 Is non-judgmental-student demonstrates an attitude of open-mindedness toward others
and situations; does not “stereotype” others or prejudge situations
 Communicates assertively - actively and appropriately engages in dialogue or discussion
 Is self-directed in undertaking tasks; self-motivated
 Is respectful-demonstrates regard for self, patients, peers, faculty, staff and university
property
 Is empathetic - demonstrates appreciation of others’ positions; attempts to identify with
others’ perspectives; demonstrates consideration towards others
 Handles stress - remains calm, level-headed and composed in critical, stressful or difficult
situations
 Is an active learner - seeks knowledge; asks questions, searches for information and takes
responsibility for one’s own learning
 Is confident - acts and communicates in a self-assured manner, yet with modesty and
humility
 Follows through with responsibilities - if a task is left incomplete or a problem is not
resolved, student seeks aid
 Is diplomatic - is fair and tactful in all dealings with patients, peers, faculty and staff
 Is appropriately attired
 Demonstrates a desire to exceed expectations - goes “above and beyond the call of duty, “
attempts to exceed minimal standards and requirements for tasks assignments and
responsibilities
 Utilizes time efficiently - allocates and utilizes appropriate amounts of time to fulfill
responsibilities; utilizes others’ time wisely
 Adheres to appropriate clinic policies and guidelines
 Understands and respects patient confidentiality and adheres to all HIPAA requirements
Professional demeanor must be maintained at all times while in clinic and class. This includes
attitude, work habits, patient communication, ethics, dress code, attendance, conduct, courtesy,
respect, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Any
observed behavior not consistent with a professional demeanor will be documented using the
Student Incident Report Form. Any significant documented behavior over the duration of the
OPTO 1700 or OPTO 1800 course series not consistent with a professional demeanor will result
in a written warning. Any subsequent incident report will result in the following:
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 24 of 95
1st report:
Written communication from the Course Director to the student outlining the infraction and a
review of the professional conduct policy including repercussions for not adhering to the
professional conduct policy
2nd report:
Meeting with the Course Director.
3rd report:
Meeting with the Course Director and Assistant Dean of Clinical Affairs.
4th report:
Meeting with the AZCOPT Dean, referral to the Student Promotion and Graduation
Committee, failure of the course, and/or dismissal from the program.
An egregious unprofessional act of conduct reported at any time may result in immediate failure
of the course, and/or dismissal from the program regardless of whether any previous Student
Incident Report has been filed.
Additionally, if a student receives a “needs improvement” (NI) on the professionalism and
conduct portion of the student clinical grading form at the midterm evaluation, a meeting with
the course director and/or the Assistant Dean of Clinical Affairs will be held to discuss
acceptable behaviors and the consequences of failure to meet the expectations for professional
conduct. If a student receives a “needs improvement” (NI) on their final evaluation, a meeting
with the AZCOPT Dean will be scheduled, as well as referral to The Office of Student Services,
and the student may receive a failing grade for the course, and/or be dismissed from the program.
Patient Management and Protocols
Students and faculty are expected to demonstrate professional demeanor when addressing a
patient and one another. When a patient is called from the waiting area they should be addressed
by either a full name or salutation of Mr., Ms. and surname. In a more private setting a second
personal identifier should be asked of the patient to assure that the correct patient has responded.
Students must introduce themselves as student clinicians, and introduce a faculty preceptor by
title and name i.e. Dr. John Smith. Private personal history and personal information should not
be queried outside of the exam room to protect patient privacy.
Professional and Appropriate Communication and Courtesies
Patient Communication Protocols
Students and faculty should always attempt to communicate in the English language to patients.
If it is felt that proper patient care cannot be delivered because the patient is unable to
comprehend or follow directions during the examination, an interpreter will be called. If an
interpreter is not available (family member, friend, faculty, etc.), the examination will be
rescheduled on a day when the presence of an interpreter can be arranged. This policy will hold
true for sign language and will be consistent with the Americans with Disabilities Act of 1990.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 25 of 95
Suggested Practice Management Procedures
A. The Greeting – The intern should greet the patient cordially in the reception area
before taking the patient back for their exam.
B. Escorting the Patient – The intern should walk next to the patient while escorting
them to the exam room. Under no circumstances should the intern discuss the reason
for the patient’s exam when walking to the exam room. This would violate HIPAA
regulations.
C. Introduce the Patient to the Supervising Faculty – this should be done when the
intern’s supervising faculty enters the exam room to briefly check the intern’s work.
D. Patient Education – The intern should always explain to the patient the procedures
being tested and the reason for each specific test. This allows the patient to
understand the examination and the purpose to the testing.
E. Leaving the Exam Room – The intern should politely excuse themselves whenever
leaving the exam room to consult with the supervising faculty. If the patient can be
left with information to read or look at this is preferred. Turn the room lights up to a
comfortable level of illumination; do not leave the patient in the dark.
F. Discussion with Faculty – The intern and faculty should discuss the results of the
patient’s exam privately in a consultation room to ensure patient privacy.
G. Ending the Exam – The intern should affirm the treatment plan (including return date)
and explain “why” with the patient afterwards. Make sure to thank the patient for
coming into the Eye Institute and that you would be happy to see anyone else they
thought may benefit from your services. The intern should present the patient with
two business cards (one for the patient and one for a friend). The student will
complete a “Thank You” letter to be mailed to the patients home address at the
conclusion of every examination.
H. Inform Patient of On-Call Policies- The intern should educate the patient of on-call
services available twenty-four hours a day, seven days a week. Patients can call, 623537-6000, after hours with any questions, concerns, or challenges concerning their
patient care.
Protocol for Patients Waiting in the Reception Area
Patients will be advised to arrive 15 minutes early for their exam to complete the registration
form or update the registration forms if the patient has been here previously. The intern should
meet the patient immediately but no later than 10 minutes after the appointment time. The intern
is responsible to monitor the patient’s arrival status and pick them up as soon as possible.
If the intern cannot start the exam with the patient immediately, the intern should advise the
patient of the delay and advise the patient of the expected time to start the exam. If the wait is
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 26 of 95
unacceptable to the patient, the intern should speak with their supervising faculty and determine
if another intern is available to assist.
If after 15 minutes past the scheduled appointment time the intern has not come to the waiting
area to communicate with the patient, the Front Office will contact the supervising faculty to
determine the course of action.
General Program Guidelines and Policies
Examination Room Care and Preparation
Student clinicians are expected to bring their equipment roller boards with all equipment in
working order. Each student clinician will be assigned to a clinical faculty preceptor and an
examination lane for each patient care session. A concerted effort will be made to arrange
assignments so student clinicians will have exposure to as many patient encounter types and
specialty areas as possible.
In the case of patient failure to appear, other clinical cases or case discussions will be assigned
by the clinical attending optometrist.
In the case of equipment failure every attempt will be made to correct the problem immediately.
The ophthalmic technician, biomedical technician, clinic manager or attending facultyshould be
notified to correct the problem. In the event correction is not possible immediately, another
examination lane will be made available.
Examination Room Equipment:
The responsibility for the condition of all the examination rooms belongs to students, as well as,
faculty. Procedures to be followed by all students are as follows:







Arrive early to prepare your examination room
Be sure you have paper towels, soap, Kleenex, needed supplies such as diagnostic dye
strips, saline or eye wash, diagnostic drugs, contact lens case, sample artificial tears,
Uncover all equipment and store the covers in the cabinet
Disinfect the examination chair surfaces, handhold bars, counter tops, computer
keyboard , mouse, acuity remote, door and cabinet knobs, and any patient contact
points on the instruments (chin or forehead rests).
Store your roller board under the counter and set up the instruments you will need
ready for use.
Turn on the acuity computer system, computer, stand power, overhead lamp, desk
light as needed and set up your diagnostic equipment
When your patient care is complete, clean and cover all equipment, turn off all power
and lights, exit the computer program and shut down the computer. Return all
supplies to their original location.
PLEASE DO NOT:

Leave the power on to anything
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 27 of 95

Use the examination room computers only for patient examination or treatment
related data. DO NOT access the internet or your email from these computers. If you
write report letters, do not save them on this computer.
Examination Room Infection Control
Each examination lane in the Eye Institute is supplied with a container of Clorox disinfection
wipes, alcohol prep pads, a box of Kleenex tissues, antibacterial hand soap and paper towels. The
Clorox wipes are specifically for disinfecting hard, surfaces only. The alcohol prep pads are
specifically for disinfecting hard surfaces that the patient’s head and face surfaces may touch.
The protocol for each examination lane is as follows:
1. Using one disinfection wipe:
a. Prior to patient care and before setting-up equipment, each Intern will wipe down:
i. all exam and side chair arm rests
ii. hand grips on instruments
iii. head rests
iv. countertops
v. computer keyboard and mouse
vi. acuity system remote control
vii. door/drawer handles/knobs
b. They should then discard the wipe and wash their hands with the antibacterial
soap and water.
2. Using alcohol wipes:
a. Wipe:
i. all chin and forehead rests
ii. face touching surfaces on the phoropter/ slit lamp/ keratometer (and any
other instruments)
iii. occluders
3. Between each patient, the chairs, headrests, armrests, computer keyboards and mouse
should be wiped down again with a disinfection wipe and alcohol wipes used on
face/chin and forehead contact areas and occluders.
4. As an infection control step in the public areas of the clinic: the wipes should be used on
any solid surface (door handles/ stair railings/counters/ telephone handsets and dial pads/
computer keyboards and mouse, elevator buttons and hand rails) every four- six hours.
5. All employees and interns can use the alcohol based hand sanitizers that are available as
well.
6. Disinfection products will be replenished on a weekly basis.
Examination Room Electronic Health Records
The Eye Institute uses the CompuLink Electronic Medical Records Software. To protect the
privacy rights of the patients the medical record should be closed and locked whenever the
clinician and/or student clinician leaves the examination lane. Electronic medical health records
should be completed at the conclusion of each patient encounter. Each patient encounter should
include all pertinent data such as: patient supplied information, examination findings,
impression, plan inclusive of recommendations and follow up, fee assessments including
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 28 of 95
notification of exclusion, if additional non-covered examination is performed, patient education,
phone conversations, referrals, and signatures of the student clinician and Clinical Preceptor. All
programs should be closed when the student clinician closes down the examination lane after
their patient care schedule. The student clinician should log off. Any letters or patient care
documents should be deleted from the desktop and the computer should be powered off.
Student Attire
Professional appearance and demeanor are critical to developing patient rapport and confidence.
Adherence to the established dress code will be factored into the students’ midpoint and final
grade in the area of professionalism. The following information outlines the dress code
requirements observed at the MWU Eye Institute. It is recommended that these requirements
also be observed at external rotation sites, unless the site has its own specific requirements that
may or may not conflict with MWU Eye Institute requirements. The external rotation site has
the ultimate authority over optometry student dress code.
a) Name Tags
Students must be identifiable by a name tag while on campus or external rotation sites.
The name tag should be kept current and should be clearly visible. The external rotation
site may also provide a name tag specific to that site.
b) Lab Jackets and Coats
AZCOPT-approved short white, long-sleeved student lab coats should be clean and
pressed at all times and are required during patient care activities (unless otherwise
approved). You may have to purchase a clinic coat without the AZCOPT logo, if
required by the site. (Student is responsible for this cost). Clothing worn beneath the lab
coat should be appropriate for a health care professional.
Proper Attire: common sense and a sense of professionalism should dictate daily attire.
 Be attentive to all aspects of your personal hygiene.
 Hair should be clean and well groomed. Long hair should be tied back. Dramatic
styles and wet hair are not appropriate. Beards should be well groomed.
 Jewelry should be kept to a minimum, with limited visible body piercings. Earrings
should be small and no longer than one inch below the lobe.
 Clothing should fit and should be clean and pressed. Clothing that has unprofessional
wording or images of any kind are not appropriate. T-shirts are not appropriate.
Baggy “sagging” pants, halter tops, backless or midriff-baring tops, and fatigues are
not considered appropriate. Sweatshirt material is not considered appropriate.
Dresses and skirts should be no more than two inches above the knee and should be
worn with appropriate hose and shoes. Mini-skirts or revealing necklines are not
appropriate.
 Tattoos should be covered.
 Perfume should not be worn in a patient care setting.
 Make-up should be kept light.
 Shoes should be appropriate. Open toe shoes are prohibited. Appropriate hosiery or
socks are to be worn at all times.
 Dress slacks, dress blouses or tailored shirts are appropriate. Ties are required.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 29 of 95

Additional pins are limited to professional organizations only. (ie. AOA, AAO,
COVD etc.) Industry-sponsored awards or logos are not appropriate.
Cell phones should be turned off or placed on “silent” mode and will be limited to
emergencies only during internal and external rotation hours. Appropriate clinical
applications may be accessed to assist in patient care. Personal use during clinic
encounters is inappropriate.
These guidelines are not all-inclusive. Students are expected to adhere to the spirit of the dress
code. The Clinical Preceptor and/or the Assistant Dean of Clinical Affairs will make the final
determination of whether a student is in compliance with these standards. An out of compliance
student will be removed from patient care immediately, will receive a failing grade for the
patient encounter, and can be referred for a professional ethics evaluation.
Alcohol/Drug Policy and Procedures
A Drug-Free Workplace and Substance Abuse Policy and Procedure has been established for
Midwestern University in order to appropriately serve the needs of faculty, staff, and students.
This policy has been established to implement a drug-free workplace and academic environment
consistent with federal and state law, including the terms and conditions whereby employees,
students, volunteers, faculty, physicians, and other professionals may be disciplined for violation
of these policies and tested for suspected use of an illegal drug or alcohol.
As part of the Drug-Free Workplace policy, entering students must sign and submit a statement
to the Office of Student Services indicating they are drug-free and that they agree to abide by the
Midwestern University’s Drug-Free Workplace and Substance Abuse Policy. The signing and
submitting of this statement occurs as part of each new student’s Orientation Program the week
prior to the onset of classes. The Dean of Students maintains these statements in the Office of
Student Services. In addition, the Office of Student Services emails a copy of the current DrugFree and Substance Abuse Policy annually to all students for their review.
Midwestern University maintains a drug-free environment consistent with the principles of the
Federal Drug-Free Schools and Communities Act and the Drug-Free Workplace Act. All offers
of employment and enrollment of students are conditional on students abiding by Midwestern
University’s Drug-Free Workplace and Substance Abuse Policy. In addition, a student who is
convicted of a state or federal offense involving the possession or sale of an illegal drug (a
controlled substance as defined by the Controlled Substance Act and does not include alcohol
and tobacco) that occurred while the student was enrolled in school and receiving Title IV aid, is
not eligible for Title IV funds. For more detailed information concerning Title IV funds and
convictions for the sale of illegal drugs see the Student Financial Services section of the catalog.
The stated policies and procedures apply to all students of Midwestern University on campus, or
at all facilities operated by the affiliated entities. The stated policies and procedures also apply
to any student who is enrolled at another academic institution but rotating in a clinical service on
the premises of a facility operated by MWU. The University reserves the right to evaluate any
student if there is a reasonable cause to suspect that he/she is abusing or is under the influence of
alcohol or illegal drugs/substances. A student is considered to be under the influence when
his/her ability to perform usual tasks is diminished or impaired due to the apparent use of an
illegal drug/substance, alcohol, or a combination thereof. Any student who attends a class or a
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 30 of 95
clinical rotation under the influence of alcohol or who is suspected of abusing drugs will be
required to undergo an immediate drug and/or alcohol screening in accordance with this policy.
While the costs of these initial drug screenings are typically the responsibility of the appropriate
college or the Office of the Dean of Students, transportation to an emergency room for those
students who are exhibiting signs of physical/mental impairment will be the responsibility of the
student.
If a student is found to have a positive drug screen and he/she is taking prescription drugs, he/she
will be asked to provide documentation to both the University and/or the Medical Review
Officer in the form of either a physician’s or pharmacist’s name and phone number where they
can be contacted for verification. If however, the student is found to have a positive drug screen
without documentation of a legitimate prescription, he/she will be subjected to disciplinary
action, which may include immediate suspension and/or medical leave. Although extreme cases
may result in expulsion, it is the intention of Midwestern University to assist students with
chemical dependencies by helping the student receive the appropriate counseling and treatment
for his/her dependency.
Criminal Background Checks
Due to growing nationwide concerns regarding the suitability of today's health care providers,
many hospitals, health care systems, clinics, physician offices, or pharmacies providing health
care services require disclosure of an individual's criminal history. In addition, many state
statutes also require disclosure of an individual's criminal history in order to apply for certain
health professional certificates, registrations, and licenses. Existence of a criminal history may
subject an individual to denial of an initial application for a certificate, registration, or license to
practice in a clinical setting or result in the revocation or suspension of an existing certificate,
registration, or license. In response to this growing trend, Midwestern University requires
students to submit to criminal background checks.
It is the policy of Midwestern University that all accepted students must submit to a criminal
background check prior to matriculation. In addition, students who remain enrolled must submit
to a criminal background check as needed to remain eligible for continued participation and/or to
participate in clinical rotations. In accordance with the laws of the State of Illinois, CCOM
students are required to undergo fingerprinting as part of the criminal background check process.
Students in other programs may also be required to undergo fingerprinting.
The criminal background check involves obtaining an authorization from a matriculating or
current student that allows the University to obtain the student's individual criminal history. The
results of the background check are reviewed by the Dean of Students to determine whether or
not there is a record of misdemeanor and/or felony convictions. If there is a positive record, the
Dean of Students will inform the appropriate Academic Dean and the Director of University Risk
Management so the University can make a determination whether the criminal history will
negatively impact the student's admission status or ability to complete the practical
training/rotation requirements of the degree program.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 31 of 95
Criminal background checks are conducted through Student Services as part of the initial student
matriculation process and on an as-needed basis thereafter while a student is actively enrolled at
Midwestern University.
1. All matriculating students must complete the Criminal Background Release and Consent
Form to conduct the criminal background check. All newly admitted students who have
submitted a matriculation deposit are provided with access to a copy of the University
policy and the Criminal Background Release and Consent Form. By going to the
Midwestern University website (http://www.midwestern.edu) and selecting MWUNET,
the student can find the Student Handbook and consent form.
2. The Office of Student Services will contract with a professional service to conduct the
criminal background check.
3. The Dean of Students will review all criminal background reports and determine whether
or not a misdemeanor or felony conviction record exists. If a felony or misdemeanor
conviction exists, the Dean of Students will conduct a criminal background investigation.
The investigation may include any of the following components:
a. Request for additional detailed information about the positive criminal
background check report. This may entail one or more meetings with the student.
b. Collection of additional data, e.g., Federal Bureau of Investigation fingerprints
and report, concerning the positive criminal background check report.
Following the criminal background investigation, the Dean of Students, in consultation
with the Academic Dean (or their designees), will determine whether or not the student
should be disqualified from matriculation or continued enrollment. Criminal convictions
will not automatically disqualify a student from enrollment or continued enrollment. The
University will consider such factors as (but not limited to) the nature of the crime, the
age of the individual at the time the crime was committed, length of time since the
conviction, the nature of the clinical program and the relatedness of the conviction, and
whether the University will be able to provide appropriate professional clinical training to
the student.
4. Failure of the student to present appropriate forms to the Office of Student Services for
the purpose of conducting criminal background checks when requested will bar the
student from initial matriculation and/or continued enrollment.
5. Students with a positive criminal background check are individually responsible for
checking the licensing and certification requirements in any state where the student is
interested in participating in a preceptorship, internship, clinic or other rotation to
determine whether or not their conviction may be a barrier to participation.
6. Students are required to disclose to the Dean of Students and appropriate Academic Dean
any arrests, criminal charges, or convictions against them during their entire period of
enrollment as a student at Midwestern University. Such arrests, criminal charges, or
convictions may negatively impact a student's ability to obtain and/or complete clinical
rotations or preceptorships.
7. Midwestern University does not guarantee clinical rotations for students who have a
history of felony or misdemeanor charges/convictions. In such cases, the University
confidentially shares information about the student’s positive criminal background
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 32 of 95
history with potential preceptors and practice site representatives as necessary and on a
need-to-know basis. This may include releasing a copy of the original Criminal
Background Check report for their review. This gives the preceptor and site
representatives an opportunity to decide whether the student is acceptable to the site. For
this reason, scheduling and completion of practical training/rotations and graduation may
be delayed. In some instances, it will not be possible to arrange for practical
training/rotations at specific sites.
a. If this information is known by the University prior to the student’s matriculation,
the Dean of Students and/or Academic Dean (or their designee) will meet with the
potential student to discuss the consequences of the positive criminal background
investigation on the student’s ability to complete degree requirements so that
appropriate action can be taken.
b. If this information is known by the University after the student’s matriculation,
the Dean of Students and/or Academic Dean (or their designee) will meet with the
student to discuss the consequences of the positive criminal background
investigation on the student’s ability to start/resume practical training/rotations
and the student’s ability to graduate so that appropriate action can be taken.
8. Records concerning a student’s positive criminal background check are stored in a
confidential file in the Student Services Office and Office of the Academic Dean.
9. In the event that a student is assigned to a practical training/rotation site that requires a
copy of the original Criminal Background Check report prior to a student’s placement at
the site, the student’s criminal background check report and cover letter will be scanned
into an encrypted password protected PDF file. The encrypted PDF file will be forwarded
via email to the rotation site coordinator.
Immunization Guidelines
Midwestern University requires that all students submit documented laboratory proof of the
absence of tuberculosis (updated yearly) and proof of immunization against measles, mumps,
rubella, varicella (chicken pox), diphtheria/tetanus, annual influenza, and hepatitis B prior to
matriculation (there may be some exceptions depending on the student’s particular program). In
addition, depending on the program, students may be further required to prove the efficacy of
their immunizations through blood titers, to measure the level of circulating antibodies
associated with these various diseases. Depending on the program, students may also be
required to submit to a drug screen. All students enrolled in clinical programs must also submit
to a completed physical form, signed by a physician, indicating the student is medically cleared
to be a student and to participate in clinical rotations.
Cost for these requirements must be paid by the student. Titers and annual drug screens,
however, can be built into the student’s financial aid budget. Any reimbursement from an
insurance plan is a matter between the student and his/her insurance carrier. Cost and other
information about immunizations/titers can be obtained from the Office of Student Services.
All students are required to provide current documentation to the Office of Student Services of
the following immunizations at least two weeks before a clinical rotation begins. Failure to
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 33 of 95
comply with immunization requirements will result in cancellation of the assigned rotation, may
cause extension of the student’s program of study, and may delay graduation.
Vaccination or tests that must be completed:
 Measles/Mumps/Rubella (MMR)
o Measles: Two dates needed or documented disease and positive titer
o Mumps: One date needed and positive titer
o Rubella: One date needed and positive titer
 Tetanus/Diphtheria: Must show proof within last 10 years
 Tuberculosis (PPD) test:
o Initial two-step PPD test with an annual one-step PPD test. If it has been greater
than one year since the PPD test, the two-step test will be required. If student has
a positive PPD test, this requires a chest X-ray and documentation annually that
the student does not have active tuberculosis (TB).
 Chickenpox (Varicella): positive titer
 Hepatitis B vaccination: three dates needed and positive Hepatitis B Surface Antibody
titer
 Influenza vaccination: annual date needed
 Other immunizations: may be required by external rotation site
Students may contact the Office of Student Services (Phone: 623-572-3210, Fax: 623-572-3287)
with questions regarding immunization requirements. Students should take all previous
immunization records with them to the Office of Student Services so that all proof of
immunizations can be recorded. A copy of current immunizations must be on file with the
Office of Student Services in order to begin clinical rotations. The student should retain a copy
to place in their records. An Immunization Compliance Letter can be downloaded and printed by
students from their student portal. Preceptors can request a copy of the Immunization
Compliance Letter from the Clinical Education Coordinator. Immunization compliance is
monitored quarterly by the Clinical Education Coordinator.
On-Line Pre-Rotation Training
Students are required to complete the following self-instructional, self-paced, (or independent
study) on-line training via Law Room before clinical experiences are assigned and renewed
annually.
 Universal Precautions Related to Blood borne Pathogens
 HIPAA Privacy and Security
 OSHA Regulations in Illness and Injury Prevention
 Anti-Harassment and Discrimination
Students will be provided with all necessary login information and instructions by the Clinical
Education Coordinator. A record of the students who completed the training is kept on file in the
Clinical Education Coordinator’s office. Failure to complete all requirements as requested by the
Clinical Education Coordinator may result in cancellation of the clinical rotation causing the
student to be placed on an extended track requiring a late graduation date as well as additional
tuition fees.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 34 of 95
Special Requirements for Clinical Rotations
Clinical rotation sites may have additional requirements such as, but not limited to: corporate online training, urine drug screens, additional health requirements, and fingerprinting. Students
will be notified in advance so that these requirements can be completed before the clinical
rotation starts. These costs will be at the student’s expense. Failure to complete all requirements
may result in cancellation of the clinical rotation causing the student to be placed on an extended
track, requiring a late graduation date as well as additional tuition and fee charges.
CPR Training
All students, prior to the start of the clinical program, must become certified in Basic Life
Support for Healthcare Providers (CPR & AED). A copy of the student’s Healthcare Provider
certification card must be submitted to the Clinical Education Coordinator before the student will
be allowed to begin their clinical experiences. Contact the Clinical Education Coordinator if your
certification will expire during your clinical rotation sequence. If the student does not have a
current CPR card and does not complete CPR training when offered, the student must make
his/her own arrangements at his/her own cost to become certified through the American Heart
Association or another organization. Proof of certification must be submitted to the Clinical
Education Coordinator at a minimum of one month prior to the start of both the third and fourth
academic year.
Liability Insurance
Midwestern University provides liability insurance for all students enrolled in the clinical
rotation program. This insurance covers students only when they are participating in the
optometry practice experiences in the United States as a part of the curriculum to satisfy
graduation requirements.
Counseling
Midwestern University provides confidential student counseling by an on-campus counselor to
help students deal with a variety of non-academic and personal concerns. Short-term counseling
is provided at no cost for all students who are currently enrolled in classes at Midwestern
University. Students who present with long-term issues are referred to known off-campus
specialists for assessment and treatment. All efforts are made to make referrals to providers on
the student’s health insurance network so that the student does not incur additional costs.
To preserve confidentiality, appointments are made directly with the Student Counselor (623572-3629). The counselor can be reached Monday through Friday during business hours to
schedule an appointment; however accommodations in scheduling are flexible for student’s offcampus or on rotations. For those students who cannot be on-campus, the counselor can provide
assistance via telephone.
If a student is failing a rotation or not performing well, the student is highly encouraged to seek
academic counseling from the Assistant Dean of Clinical Education, 623-806-7211, Associate
Dean of Academic Affairs, 623-572-3941, or the Dean, 623-572-3901.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 35 of 95
Disability Statement or Medical Concerns
If you require accommodation for reasons such as a disability, if you have emergency medical
information (e.g. medication or food allergy), or if you need special arrangements in case the
building must be evacuated, please notify the Office of the Dean of Students as well as the
Clinical Education Coordinator. All requests for accommodations must be processed by the
Midwestern University Dean of Students, following the guidelines outlined in the Midwestern
University Student Handbook. Students should review any information regarding approved
accommodations with their clinical preceptor on the first day of rotation.
Compensation
Students cannot receive payment, gifts, or rewards for any work for which they receive academic
credit. There is no monetary compensation to students for participation in the external rotations.
Students are responsible for all transportation, housing, food and any other personal expenses
associated with their clinical rotations. In rare cases, site-specific housing may be provided for
students.
Travel and Lodging for Clinical Rotations
It is the student’s responsibility to assure that he/she has made appropriate arrangements for
lodging and transportation to/from clinical education/rotation/fieldwork sites throughout the
curriculum. The University does not generally provide for the cost of transportation and lodging.
Travel arrangements are the sole responsibility of the student. Students are not considered an
agent or employee of the University and are not insured for any accidents or mishaps that may
occur during any traveling that is done as part of the student’s professional program. Students
are usually responsible for all expenses associated with clinical education, such as transportation,
meals, housing, professional attire, laboratory fees, etc.
Communications
Internet access is available in the Eye Institute. Such Internet use is to be limited to professional
communication and the student’s current practice-related tasks. Internet access for personal use
is available on-campus, public libraries, and other local Wi-Fi locations.
College faculty and administrators will use electronic means, in addition to regular mail, to
communicate with students. This information may be important and/or time sensitive. Thus, the
following are expectations of the College:
 All students are required to check their University e-mail account on a daily basis.
Official, “in writing” college and campus-wide communications are sent to students over
e-mail. Students are responsible for information that is transmitted through this
electronic medium (see Computer Code of Conduct in the MWU Student Handbook).
The student University e-mail account is the only electronic mailing address recognized
by the University. The University and its employees are not responsible for forwarding
email to students at personal email accounts that are not held by the University.
Information included in the student emails should follow the guidelines of appropriate
professional conduct. (See Computer Code of Conduct and Appendix 4, Section 2,
Subsections a and b under Grounds for Action: Academic and Professional Misconduct
of the MWU Student Handbook).
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 36 of 95

Lack of access to electronic communication is not a valid excuse for failure to respond to
a request, perform an assignment, or meet a deadline.
Academic Honesty
Academic honesty and integrity are expected of all students throughout their course of study at
Midwestern University. Academic dishonesty is intentional cheating, fabrication, or plagiarism.
It is also knowingly helping or attempting to help others be dishonest. Academic dishonesty
lowers scholastic quality and defrauds those who will eventually depend upon your knowledge
and integrity. Any violation of this code is considered to be a serious academic violation and
may result in a reprimand, written warning, academic and/or disciplinary probation, suspension,
or dismissal. Academic dishonesty constitutes a breach of academic integrity that violates the
academic foundation of an institution and compromises the integrity and well-being of the
educational program. The policies on students’ academic and professional responsibilities are
included in the Appendices 1 through 4 of the Midwestern University Student Handbook.
Professional Misconduct
Violation of the policies, procedures and protocols of Midwestern University, the Arizona
College of Optometry, or affiliated clinical rotation site constitutes academic or professional
misconduct. Professional misconduct includes (but is not limited to) dishonesty involving any
component of clinical care or patient records by alteration, fabrication, forgery of signatures;
excessive unexcused absences; practicing optometry without a license; use of the clinic for
financial gains, or receiving a fee for services rendered or materials ordered. Patient
endangerment or abandonment also represents professional misconduct. Any form of
professional misconduct is grounds for disciplinary action as outlined in the Midwestern
University Student Handbook.
Concerns
Students and preceptors should contact the Assistant Director, Clinical Rotations to report
verbally and/or in writing, violations of optometry rotation program policies. This includes
alleged ethical and legal violations of the practice of optometry, alleged sexual harassment,
verbal abuse, inappropriate and offensive physical contact and any form of discrimination.
These types of incidents should be reported immediately. Immediate reporting of such incidents
will allow the appropriate action to be taken in accordance with Midwestern University
AZCOPT policies.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 37 of 95
Clinical Rotation Policies
Student Schedule
The internal rotation program goal is for each third year student to initially average 8 hours of
patient contact per week and increase this to 16 hours per week by the second quarter of clinical
experience. Early rotations may have less direct patient contact as the student’s abilities are
being assessed and the student becomes familiar with clinic policies and procedures and patient
care skills. As the student adapts to the clinical procedures and increases efficiency, the patient
contact time will increase with sequential quarters. The first quarter of clinical experience for
third year clinicians will allow for appointment slots of 2 hours, the second quarter will allow
appointment slots of 1 hour and 45 minutes, the third quarter will allow appointment slots of 1
hour and 30 minutes, and the fourth quarter will allow appointment slots of 1 hour and 15
minutes. Fourth year students on rotation in the Eye Institute will be scheduled for 1 hour
primary care appointment slots. One to three hour specialty care appointment slots will be
scheduled for either third or fourth year student clinicians depending on the specialty service
provided. Fourth year clinicians will be scheduled in the Eye Institute or its affiliated clinics to a
40-hour work week; each rotation will be scheduled for 12 weeks in length instead of the 10
week long rotation schedule of the third year student clinicians. Fourth year student clinicians are
not limited to a 40-hour work week and may be assigned at all times that the Eye Institute is
open.
Student Clinician Attendance Policy
Attendance is mandatory for all assigned clinic sessions. Students are responsible to report 15
minutes before the assigned clinic session starts.
Students must remain in the assigned clinic (e.g., Primary Care, Contact Lens, Vision
Rehabilitation, Pediatrics etc.) or classroom of the Eye Institute at all times until all patients have
been examined and the attending doctor has released the student. In the Eye Institute the second
floor classroom will be utilized for case presentations and class instruction. All possible
consideration will be made to complete the clinical assignments within the business day. If the
student needs to leave the clinic during their shift, the student must obtain permission from the
clinical attending faculty and notify the reception desk of the student’s whereabouts.

Excused Absence for a Personal Reason
Make-up requirements for excused absences for a personal reason (i.e. illness, family
issues) will be determined by the Course Director and or the Assistant Dean of Clinical
Affairs while located at the Eye Institute. Make up requirements for excused absences
while at an external rotation will be determined by the external rotation site preceptor.
Failure to comply with any portion of the attendance policy or the process for requesting
time-off will be considered an unexcused absence. An unexcused absence is grounds for
a failure of a rotation Time off for these reasons is limited to a maximum of two days
during the last academic year of the program.

Excused Absence for a Professional Reason
Professional time is a benefit that fourth year students can use for activities that further
their professional career (i.e., interviews for residency programs, attendance at
professional meetings of scientific organizations, etc.) Fourth year students may be
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 38 of 95
granted a maximum of six (6) professional days off during the last academic year of their
program. In the case of an external rotation site closure or activity other than patient
care, the external rotation site will notify in advance the Clinical Education Coordinator.
AZCOPT students are required to take National Boards. Time off for National Boards is
excused. Travel time to and from National Boards Part III is also excused, but this time
must be approved by the Clinical Education Coordinator, the Assistant Director, Clinical
Rotations, the external preceptor, and the office of the Dean. Approved time off for this
purpose is applied to the six (6) professional days off during the last academic year of the
program. Failure to comply with any portion of the attendance policy or the process for
requesting time-off, will be considered an unexcused absence. An unexcused absence is
grounds for a failure of a rotation. All excused absences must be reported to the Clinical
Education Coordinator and appropriate Clinical Rotation Absence Forms completed and
submitted.
Part I: March and August
Part II: December and April
Part III: variable dates throughout the year
State Law: varies by state

For those that are rotating through the Eye Institute at the time of the National Board
Exams the day before the National Boards exam may be excused for first time test takers.
.
Jury Duty
If any 3rd or 4th year student receives their first summons for jury duty, the AZCOPT Clinical
Course Director or Clinical Education Coordinator recommends that students first postpone their
summons online as indicated on the letter received from the court. If students get a second
summons, they should bring the summons to the Office of Student Services. The Office of
Student Services will write a letter for the student, asking for a delay in jury duty. The next time
a student receives a summons, a letter cannot be written and the student should appear for jury
duty. The student should inform the court that selection would result in hardship. An absence
for jury duty needs to be documented, and a copy of the summons given to the Clinical
Education Coordinator prior to the duty date.
Maternity Leave / Prolonged Illness Policy
Enrolled students who become pregnant can request a leave of absence for maternity reasons.
The request must be in writing and sent to the Dean; however, prior to officially requesting a
maternity leave, pregnant students must contact the Office of the Dean to discuss how the leave
will affect their progress in the academic program and review options available to them. The
amount of leave time granted depends largely on the personal needs of the student and the timing
of the birth within the academic program. In addition, students must inform the Office of the
Dean of their intentions to return to classes at least one month prior to the end of the leave of
absence period. A final decision is reached after careful consideration is given to the personal
and professional circumstances.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 39 of 95
For maternity or illness reasons, if more than ten clinic days (not to exceed 80 hours of clinic
time), of assigned clinic time during an OD-3 or OD-4 rotation block is missed, the rotation will
be cancelled and the student will be rescheduled for a replacement rotation at the start of the next
regularly scheduled rotation block. Rotation rescheduling to the same site/ clinic as previously
assigned cannot be guaranteed. As a result of the rescheduling, the student’s completion of
graduation requirements will be delayed and the student may not qualify to participate in the
graduation ceremony for his/her class. No exceptions will be made to this policy.
Process for Requesting Planned Time Off in Advance
Requests for days off are often approved on a first come, first serve basis. The following process
of taking time off must be followed and it is possible that at any point in this process your
request may be denied at the discretion of the College. A Request for Clinical Rotation Absence
form must be submitted by the student a minimum of 2 weeks in advance of the date of absence
and approved by the following individuals in the following order:
Eye Institute rotation:
1. The Preceptor for approval
2. The Clinical Education Coordinator for approval
The student must be signed out of the clinical assignment to be missed and signed
in to the make-up clinic assignment (if required). (Copies of supporting
documentation of invitations or conference date times etc. may be requested at
this time).
3. The Clinic Manager for approval and to make the appropriate adjustments to the
clinic schedule
4. The Assistant Director, Clinical Rotations for approval
5. The Office of the Dean for final signature and approval
External Rotations:
1. The Clinical Education Coordinator for approval
The student must be signed out of the clinical assignment to be missed and signed
in to the make-up clinic assignment (if required). (Copies of supporting
documentation of invitations or conference date times etc. may be requested at
this time).
2. To the Assistant Director, Clinical Rotations for approval
3. The external rotation preceptor for final approval. The external rotation preceptor can
deny any absence request, regardless if approved by the College.
4. The Office of the Dean for final signature and approval
NOTE: At any point in this process the approval can be denied if just cause is
determined. Flight reservations, professional conference or meeting documentation may
be requested from the student at any time during this process. It is suggested that the
student obtain approval before purchasing any tickets for transportation and payment of
any meeting registrations fees. Midwestern University is not responsible for any
cancellation fees for reservations that are made prior to approval being given.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 40 of 95
Non-Planned Absence due to Personal Illness or Family Emergencies
If unforeseen circumstances make an absence necessary, such as illness or accident, the student
must notify the preceptor or designated contact if out on external rotations. The Assistant
Director, Clinical Rotations and/or the Assistant Dean of Clinical Affairs should be notified at
the earliest possible opportunity. If the student is currently at the Eye Institute they must contact
the Clinical Educational Coordinator and the Clinic Manager. by 8:00 am of the assigned clinic
day. Failure to notify the Clinic Manager and/or the Clinical Education Coordinator will result
in an unexcused absence for the day. An absence not reported to the appropriate contact will be
considered an unexcused absence and may result in rotation failure. The clinical make-up time
will be scheduled with a one-to-one ratio if a doctor’s note or verifying documentation is
provided on the day of the student’s return; otherwise the absence is considered unexcused and
will result in a two-for-one make-up.
Off Campus Activities
Any students seeking permission to attend an off-campus conference or program must be in good
academic and professional standing.
Midwestern University approved student organizations must seek and be granted permission
from the appropriate college dean or program/division director to send student representatives to
an off-campus activity. This written request (usually made by the president of the organization)
must be made at least one month prior to the activity.
Students who desire to attend an approved off-campus activity must submit a Request for
Clinical Rotation Absence form and supporting documentation to the Clinical Education
Coordinator. Once the Clinical Education Coordinator has approved the absence request, the
form will be submitted to the course director and/or the Assistant Director, Clinical Rotations, to
the student’s preceptor(s), then to the Assistant Dean of Clinical Affairs for final approval and
filing. Approved and completed forms, along with supporting documentation are to be submitted
to the Clinical Education Coordinator at a minimum of two weeks prior to the scheduled absence
dates. Students in both the Eye Institute and external site rotations need to follow these
guidelines for an excused absence.
Students attending off-campus conferences or events must take full responsibility for making up
any missed clinic, classes, laboratories, examinations, or other course assignments. The Request
for Clinical Rotation Absence form may be obtained from the Office of the Dean, RMS, or the
Clinical Education Coordinator.
Requesting Schedule Changes
Generally schedule changes are not allowed for Third or Fourth year students. If there are
extraordinary circumstances, requests can be made to the Clinical Education Coordinator,
Assistant Director, Clinical Rotations or the Assistant Dean of Clinical Affairs. Such requests
will be considered on a case-by-case basis. Clinic schedules may not be traded with other
students.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 41 of 95
Externship Failure (refers to OPTO 1800, 1810, 1820, and 1830 Clinical Services XI-XIV)
Externships are completed sequentially. If a student receives an “F/WF” in an externship he/she
may appeal the failing grade, in writing to the course director. This must be done within 3
calendar days after the grade is posted. In this case the course director will review the premise of
the failure and the college policies regarding course failures. After consideration of the
circumstances of the “F/WF”, the course director will either accept or reject the appeal and must
inform the student, in writing, within 5 working days of this decision. If the appeal is accepted
the course director may place the student on an individualized education plan (IEP) under the
direction of the course director and require that the student take coursework. The course
director’s options are not limited to the above and can be modified on a case-by-case basis. If
the course director decides to uphold the “F/WF”, the matter will be forwarded to the Status
Promotion Graduation Committee who may exercise any combination of the following sequence:
a.
b.
c.
d.
Place the student in an extended program, if eligible;
Put the student on a leave of absence to undergo a period of independent study;
Require the student to repeat the failed externship rotation; or
Be dismissed from the program
If a student receives an “F/WF” in an externship he/she may also petition the course director, in
writing, to retake the same type of externship, if available. This petition must be filed within 3
working days of the failing grade being posted. The timing of any reassignment will be as early
as possible once the student has satisfied the committee’s requirements or concurrent completion
with reassignment and is subject to availability of sites as determined by the College. The
reassignment, if granted, must be completed within 12 calendar months of the date the petition is
received by the course director. If the student does not successfully complete the assigned
options or receives an “F/WF” in the reassigned or repeated externship he/she will be dismissed
from the program. Students are allowed only one failed or withdrawn failed externship, and only
one retake of the failed or withdrawn failed externship while enrolled at the college.
Clinical Education Remediation Policy
The Arizona College of Optometry clinical education remediation policy is based on the
following concept: Clinical education is an interactive process and successful clinical
performance requires the full participation of the student. A student who has difficulty in areas
of clinical performance (that have been identified by low scores on the grading form or by
observation of clinical skills) is expected to seek help, to identify and understand the problem,
and to take an active role in correcting it. Faculty and preceptors may provide intense
supervision at the student’s request; ultimately, however, the success of remediation depends on
the student.
Specifically if a clinical attending/external preceptor notifies the college of concerns or failure of
the performance of a student clinician and there are documented deficiencies in expected
competencies, remediation in the form of an individual education plan (IEP) may be created to
assist the student in the documented deficiencies. The individual education plan will be
developed and implemented by the Assistant Director, Clinical Rotations in concert with the
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 42 of 95
Assistant Dean of Clinical Affairs at the request of any clinical attending faculty and/or if failure
of the student is reported at midterm evaluations.
The IEP will be constructed to the following format:
1. Clearly identify the area(s) of deficiency
2. Outlines activities to enhance the student’s clinical understanding and skills related to the
area(s) of deficiency
Student clinicians may be suspended from direct patient care if patient safety is an identified risk.
This would be considered a failure of the rotation and dealt with according to Midwestern
University Policies.
It is up to the student to work towards the set goals. Re-assessment will be made during the rest
of the quarter but ultimately the final grade will determine if the student has successfully passed
the rotation. Although maximum effort may be exerted by the student in the event of a potential
failure, this does not guarantee a passing grade. The student’s expectations of themselves as well
as the attending’s expectations will be higher at the final than the midterm and it is possible that
the effort may not be enough to have achieved a final passing grade.
Extended Program
Problems may arise that may necessitate the deceleration of a student’s academic course load.
Accordingly, an individual’s academic course load may be reduced so that the student enters
what is termed an extended program or split academic course of study. Such a program
rearranges the course schedule so that the normal time period for the program is extended,
usually by one additional year. Only enrolled students may enter an extended program. To enter
an extended program, either one or both of the following conditions must be met:
1. Personal hardship. If a student is experiencing unusual stresses in life and an extended
academic load could alleviate added stress, the student may petition the College for an
extended program. This petition must be submitted to the Dean or Associate Dean of
Academic Affairs and may not be automatically granted but may be approved in exceptional
circumstances. The Dean, Associate Dean, and the Assistant Dean are responsible for
reviewing and assessing the petition and may forward to the Student Promotion and
Graduation Committee if appropriate. The student will be informed of the decision, in
writing, by the Associate Dean of Academic Affairs.
2. Academic. As described above, a student ending an academic year with an annual GPA of
less than 2.0 may be given the option to repeat courses from that year in which “F” grades
were received. A student may be placed on an extended program for academic reasons at the
discretion of the Student Promotion and Graduation Committee. A student placed on an
extended program for academic reasons is automatically placed on academic probation and
may not be returned to good academic standing until the extended program is completed.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 43 of 95
If a student is placed on an extended program, such action does not modify or limit the
committee’s actions for dismissal. Thus, the student may be dismissed for academic reasons
while on an extended program.
A student placed on an extended program for academic reasons will be returned to good
academic standing when he/she reenters the prescribed academic program and completes all
courses that were unsatisfactory and are required for graduation.
A reentering student must achieve a cumulative grade point average of 2.00 at the end of each
quarter to continue at the college. A student is allowed to go through an extended program only
once.
Grade Appeals Policy
a) Appeal of Non-Failing Course Grades
A student who wishes to appeal a non-failing course grade must make the appeal to the
course director within one week following the receipt of the grade. The course director
must act upon the student’s appeal within one week following the receipt of that appeal.
A narrative explaining the basis of the appeal must accompany the request. An appeal
must be based on one of the following premises:
 Factual errors in course assessment tools
 Mathematical error in calculating the final grade
 Bias
If the appeal is denied, the student has the right to appeal the decision to the course director’s
immediate supervisor within one week of receipt of the course director’s denial. The
course director’s supervisor should notify the student of his/her decision within one week
following receipt of the student’s re-appeal. The decision of the course director’s
supervisor is final.
b) Appeal of Course Grades Subject to Academic Review
A student whose academic progress will be subject to review by the Student Promotion
and Graduation Committee and who wishes to appeal a grade must do so in an expedited
manner prior to the scheduled meeting of the Committee. In this case, an appeal of a
course grade must be submitted within 24 hours following receipt of the grade and must
be based on one of the premises stated above. The course director must act on this appeal
within 24 hours. Any appeal of this decision will be addressed by the course director’s
supervisor. An appeal of a failing clinical rotation grade must be submitted within one
week after a grade for rotation is posted. The course director must act on this appeal
within one week of receipt of the grade appeal. Any appeal of this decision will be
addressed by the course director’s supervisor. The student is responsible for notifying the
chair of the Student Promotion and Graduation Committee that a grade appeal has been
filed prior to the meeting of the Committee.
All appeals and decisions must be communicated in written form.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 44 of 95
Dismissal or Removal from Clinical Rotation Sites
Establishing clinical rotation sites, whether local or remote, requires a great deal of time and
effort. The College and the site must maintain a mutually beneficial partnership. Students are
required to meet and maintain the highest professional standards. Under certain circumstances,
the Assistant Director, Clinical Rotations (for External Sites) reserves the right to cancel its
obligation to provide a rotation assignment for students who exhibit unprofessional behaviors as
defined by the Midwestern University Student Handbook. This includes, but is not limited to,
any student who steals any assets, property and/or drugs from any participating facility will be
denied the privilege of participation in the rotation. Students recognized as being under the
influence of any drug substance for non-medical purposes while on a clinical rotation may also
lose their participation privilege. Such breaches will result in appropriate disciplinary actions.
Preceptors may request the student’s removal from patient care regardless of the location, if it
has been determined that the student is potentially harmful to patient care, incompetent, behaving
inappropriately, and/or exhibiting academic or professional misconduct. If the student violates
any of the policies or procedures of the rotation site or the College, does not clear the
background check, does not provide proof of proper immunizations, does not pass a drug screen,
or fails to meet other necessary requirements, the student may have their rotation assignment
cancelled.
If a student is removed from a clinical rotation or dismissed by the preceptor at the site or by the
Assistant Director, Clinical Rotations, the student will not be placed at another external clinical
site for that rotation block, will receive a failing grade, and will be subject to further review and
action by the College Student Promotion and Graduation Committee (SPGC), and/or the
Assistant Dean of Clinical Affairs.
The purpose of this policy is to ensure patient’s safety, honor the privilege of participating in the
practice site, protect and support the preceptor, and maintain the College’s reputation. Student
conduct is expected to be exemplary at all times.
It is considered unprofessional conduct if the student were to argue, beg and or plead in the event
of a failing grade, and/or removal from a rotation. In the event that this happens, please contact
the Assistant Director, Clinical Rotations immediately.
Clinical Rotation Requirements
Scope of Clinical Experiences
Students want and need to be exposed to as many full-scope primary care clinical experiences as
possible. In addition, patient encounters in specialty areas such as contact lenses, ocular
prosthetics, pediatrics, low vision, ocular disease, geriatrics, electro-diagnosis and vision therapy
are beneficial and will be available within the Eye Institute. If specific categories of patients are
not available in the Eye Institute, the student may experience some of these special encounters at
AZCOPT affiliated clinical sites or when on their external rotations.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 45 of 95
Practice Management
One of the identified shortcomings of traditional optometric education is the lack of adequate
training in optometric practice management. With this in mind, the students should be exposed
to as much clinical practice management as possible within the Eye Institute and at each external
rotation site. The appointment scheduling process, patient flow within the clinic, billing and
coding, and staff management are all important aspects of optometric practice. The student
should gain exposure to all aspects of daily operations. Students should be encouraged to take
advantage of this time and these opportunities.
Professional Portfolio
Students are required to have their updated Professional Portfolio readily available at all times
during clinical rotations. This should be shared with the preceptor at the beginning of the
clinical rotation. Failure to adhere to this program requirement will be handled on a case-by-case
basis. Students completing out-of-state clinical rotations in their fourth professional year may be
required, at their expense, to mail updates of their Professional Portfolio to the Clinical
Education Coordinator or Assistant Director, Clinical Rotations upon request.
Professional Portfolio Requirements Prior to Start of Clinical Rotations
(Place all information in Portfolio in this order)









Updated Curriculum Vitae
Student’s Goals and Expectations (Career Goals and Rotation Goals)
Emergency Contact Information
Immunization Record (Obtained from Clinical Education Coordinator)
CPR Certification Documentation
Annual Universal Precautions Related to Blood borne Pathogens Certificate
Annual HIPAA Privacy and Security Certificate
Annual OSHA Regulations in Illness and Injury Prevention Certificate
Health Insurance Coverage and Copy of Health Insurance Card
General Timeline of External Rotations Requirements
PRIOR TO START OF ROTATION
 Contact preceptor at least 2-6 weeks before the start of the external rotation. If unable to
contact them for any reason, contact the Clinical Education Coordinator immediately.
 Update CV and other documents for current portfolio.
WEEKS 1 through 3
 Site orientation
 Familiarize self with site’s policies and procedures
 Review portfolio with preceptor
 Set goals and expectations (for student and preceptor)
 Complete Patient Activity Log
WEEKS 4 through 7
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 46 of 95


Mid-Rotation evaluation completed and reviewed with the student
Complete Patient Activity Log
WEEKS 8-11
 Review with preceptor a plan to complete any remaining work for the rotation
 Complete Patient Activity Log
WEEK 12
 Final evaluation to be completed by preceptor and reviewed with student
 Complete Patient Activity and anonymous and confidential Student Evaluation of the Site
and Preceptor (if not completed after 3 calendar days of the end date of the rotation an
incomplete will be given).
External Rotation Site Selection









Students will identify external rotation site preferences from a list of AZCOPT-affiliated
sites provided by the Clinical Education Coordinator.
Students will be required to rotate through at least one disease designated rotation site.
This includes a Veteran’s Affairs Hopsital, Indian Health Service and Bascom Palmer.
To prevent conflicts of interest, the student will not be allowed to complete an external
rotation with a family member, current/former partner, friend, or colleague.
Students are not permitted to complete external rotations at sites where he/she is currently
and/or has previously been employed, unless the rotation experience is determined to be
different educationally. The Assistant Director, Clinical Rotations will review requests
and finalize rotation schedules on an individual basis.
Final external rotation assignments are at the discretion of the Assistant Director, Clinical
Rotations, and if needed, the Assistant Dean of Clinical Affairs, following review of
student site preferences, professional experience, considerations of site characteristics,
College commitments to the site and rotation site availability.
External rotations will be completed at AZCOPT-affiliated sites. The student is
responsible for any financial costs incurred for travel and housing during the external
rotation program.
Once the external rotations schedules are finalized, students may not drop, change, or
cancel rotations unless the student demonstrates that an extreme hardship exists, and the
change in rotation assignment is approved by the Assistant Director, Clinical Rotations
and the Assistant Dean of Clinical Affairs. In the case of a rotation reassignment, the
student may have a delayed start that requires a later graduation date as well as additional
tuition and fee charges.
In unforeseen circumstances, a rotation site may become unavailable and necessitate a
change in the student’s schedule. In these instances, the Assistant Director, Clinical
Rotations will handle all reassignments.
Students are not to make arrangements or travel plans that affect rotation schedules
before receiving permission from their assigned preceptors.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 47 of 95

The student is not allowed to at any point contact a site on their own without the proper
permission to try and change their rotation assignments or obtain a new assignment in the
event their original site got canceled. This is considered unprofessional conduct and
could be subject to disciplinary action or a failing course grade due to poor professional
conduct.
O.D.-3 Rotation Specific Information
AZCOPT OD-3 Rotation Schedule 2014-2015
OPTO 1770 Clinical Services VII, Summer Quarter (June 2- August 8, 2014)
OPTO 1771 Clinical Services VIII, Fall Quarter (August 25- October 31, 2014)
OPTO 1772 Clinical Services IX, Winter Quarter (December 1, 2014- February 20, 2015)
OPTO 1773 Clinical Services X, Spring Quarter (March 9- May 15, 201)
Midwestern University Holidays
The student will be scheduled according to the regular work day and holiday schedule of the
MWU Eye Institute site. The following are Midwestern University holidays observed at the Eye
Institute:









Independence Day-July 4, 2014
Labor Day-September 1, 2014
Thanksgiving Holidays-November 27-28, 2014
Christmas Eve-December 24, 2014
Christmas Holidays-December 25-26, 2014
New Year’s Eve-December 31, 2014
New Year’s Day-January 1, 2015
Martin Luther King, Jr. Day-January 19, 2015
Memorial Day- May 15, 2015
O.D.-4 Rotation Specific Information
AZCOPT OD-4 Rotation Schedule 2014-2015
Kenneth A. Suarez Annual Research Day - Capstone Poster Presentation – TBD
Rotation 1-OPTO 1800, Summer Quarter (May 26 – August 13, 2014)
Rotation 2-OPTO 1810, Fall Quarter (August 18 – November 3, 2014)
Rotation 3-OPTO 1820, Winter Quarter (November 10 – February 18, 2015)
Rotation 4-OPTO 1830, Spring Quarter (February 23 – May 15, 2015)
Clinic Make-up: All clinic days after May 15, 2015
Midwestern University Holidays
The student will be scheduled according to the regular work day and holiday schedule of the
external rotation site. The following are Midwestern University holidays (no classes held), but
the external rotation site preceptor is not obligated to observe this schedule:
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 48 of 95









Independence Day-July 4, 2014
Labor Day-September 1, 2014
Thanksgiving Holidays-November 27-28, 2014
Christmas Eve-December 24, 2014
Christmas Holidays-December 25-26, 2014
New Year’s Eve-December 31, 2014
New Year’s Day-January 1, 2015
Martin Luther King, Jr. Day-January 19, 2015
Memorial Day- May 15, 2015
Class of 2014 Pre-Graduation Activities
Students are required to attend mandatory activities on campus prior to graduation on May 28,
2015. More information regarding dates and schedules as well as the financial aid exit
interviews, AZCOPT focus groups, AZCOPT Student Survey, Post-AZCOPT student survey,
and AZCOPT lectures and debriefings at a later date.
Class of 2014 Graduation
Students will graduate at Midwestern University campus in Glendale, Arizona on May 28, 2015
Overview of Rotation Requirements for Third- and Fourth-Year Students
Clinical experiential sequences will vary depending upon the availability of affiliated external
rotation sites, students’ preferences for rotation assignments, and the rotation schedule
determined by the Office of the AZCOPT Assistant Dean of Clinical Affairs. Each student is
expected to complete four consecutive quarters of study during each of the last two professional
years.
1. Course Description
The Rotation Program consists of fourth-year optometry students being assigned to
rotation sites. The purpose of these rotations is to provide the student the opportunity to
be mentored and taught by outstanding practitioners in primary and/or secondary care
optometry settings. The Rotation Program is an essential and integral part of the
curriculum, designed to contribute to the transformation of students into complete health
care professionals who can apply scientific knowledge and clinical abilities for the
benefit of patients. The student is expected to participate in patient care under the
instruction and guidance of Faculty, according to the highest standards of clinical, moral
and ethical conduct.
2. Educational Objectives
It is expected that students’ cognitive, technical and analytical skills will continuously
improve over the fourth-year experience. It is expected that their knowledge base will be
broadened and deepened during the external rotations, and that interpersonal skills,
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 49 of 95
attitudes and values will improve throughout the process. AZCOPT graduates are
expected to have achieved entry-level competence that allows them to independently
manage the most common eye and vision care needs of patients accurately and
efficiently. Graduates are expected to manage conditions that may be outside entry-level
competence through effective utilization of appropriate referral or consultation. In
addition, the externship experience is intended to provide opportunities for students to
interact within a practice or other health care institution in a manner that furthers their
ability to establish themselves in a setting that is conducive to the provision of excellent
services to patients and results in a satisfying and successful professional career.
3. OD Daily Patient Encounter Log
The OD Daily Patient Encounter Log is to be completed daily during each quarter of
internal and external rotations. This is part of a total patient care requirement necessary
for graduation as well as accreditation purposes. These logs represent the minimum
number of patient encounters required during the extern’s clinical education.
Demographics such as age, race and gender for each patient will be logged. In addition
Patient encounters are to be logged into the following areas:
Exam Type:
Primary Care
Contact Lenses/Prosthetics
Ocular Disease
Peds/Binocular Vision
Vision Therapy
Low Vision
Specialty Testing
Optical/Dispensing
Vision Screening
Observation
Follow-up
Diagnosis:
Refractive Error
Anterior Segment Disease
Posterior Segment Disease
Glaucoma
Neurologic Disorder
Binocular Vision Disorder
Diabetes
Hypertension
Example: If a student sees a patient for a routine primary care exam that also wears
contact lenses, the student will mark: primary care and contact lenses as the exam type.
If this same patient also has diabetes and hypertension along with corneal scars from
previous overuse of contacts, the student will mark: refractive error, anterior segment
disease, diabetes, and hypertension in the diagnosis box.
All Logs will be reviewed by the Clinical Education Coordinator and/or the Assistant Director,
Clinical Rotations. Third year students must complete their logs daily or at a minimum within
24 hours of the encounter or they will not receive a grade for the encounters of that day. Fourth
year students have 3 calendar days to accurately complete the log from the last day of the
rotation; if the log has not been accurately completed during that time, the course director will
post an “I” for incomplete as the final grade. All incomplete grades must be resolved within 10
calendar days starting from the last day of the external rotation for the quarter. If an incomplete
grade remains beyond the 10 calendar days, it is automatically converted to a grade of “F” by the
Registrar, which signifies failure of the course. This will be dealt with like all other failing
course grades according to Midwestern University policies.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 50 of 95
4. Third Year Patient Evaluation Form
During the third professional year the students will receive evaluations on every patient
encounter. The Patient Evaluation Form for the third year student clinical experience will
be completed after each patient care experience by the attending clinical faculty. This is
completed on-line in the Meditrek system and should be completed within 24 hours of the
patient encounter.
5. Fourth Year Evaluation Form
With support from the Assistant Director, Clinical Rotations as required, preceptors must
evaluate student performance at a minimum at the midpoint and end of each rotation,
identify strengths and weaknesses and provide learning opportunities to ensure student
development in the established competency areas. Constructive and regular feedback to
the student is a critical element in ensuring appropriate student development. If a
preceptor is away on vacation or will otherwise be unavailable to complete the final
evaluation, the preceptor or site should notify the Assistant Director, Clinical Rotations of
the situation immediately. It is very important that preceptors contact the Assistant
Director, Clinical Rotations with any concerns regarding a student in any area, as
documentation is required from the University to substantiate a poor performer or any
course failure.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 51 of 95
SAFETY PROCEDURES FOR THE EYE INSTITUTE
MWU Emergency Response Plan
The Emergency Response Plan for the Arizona Campus of Midwestern University is available on
the homepage:
http://mwunet.midwestern.edu/administrative/ERT/documents/Emergency%20Response%20pla
n%201-12.doc
MWU Emergency Response Team
MWU recognizes that critical incidents affecting students, faculty, and staff will occur and can
have a significant effect on individual students, faculty, and staff, their families, and the
University community. To plan for and respond to these situations, MWU has created the
Emergency Response Team (ERT).
Midwestern University ERT Members
Erik Carroll
Christina Taylor
Kathy Dooley
Ron Enos
Bill Frantz
Scott Shuman
Ross Kosinski, PhD
Vladimir Yevseyenkov, OD, PhD
Shannon Sesterhenn, PhD
Nicole Chavez
Karen Mattox
James Pashayan, DDS, MAEd
x3326
x3772
x3346
x3270
x3316
x3945
x3329
x7206
x3357
x6351
x3310
x7011
Information Technology Services
Human Resources
Media Resources
Safety & Security
Campus Facilities
Risk Management
Student Services
Eye Institute
Student Services
Multispecialty Clinic
Communications
Dental Clinic
Eye Institute Emergency Response Plan
In the case of an emergency call 911, and then Safety & Security at x3201.
Protocol for AED and CPR
To assist in a medical emergency, first aid kits are located on the first floor in the administration
suite and second floor in the pharmacy room. An automated external defibrillator (AED) is
located on the first and second floor of the Eye Institute adjacent to the restrooms. Automatic
External Defibrillators (AED) can save a life during a medical emergency. The AED device
talks the provider through a process of evaluating a patient for, attaching the patient to, and
activating the AED therapy. The University provides CPR and AED training on a regular basis.
Additionally, an AED/CPR quick reference guide can be found on the home page:
http://mwunet.midwestern.edu/administrative/ERT/CPR_AED.htm
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 52 of 95
Location of Emergency/Courtesy Phones
There are three colors of emergency/courtesy phones available throughout campus. All of the
phones connect you directly to Safety & Security in the Welcome Center.
RED: Emergency Phones in campus buildings, typically seen near the building exits
BLUE: Courtesy Phones in parking lots, parking structures and along sidewalks on campus
YELLOW: Courtesy Phones in student housing
If you see an emergency, or if you need a walk to your car at night, observe suspicious behavior,
find a lost wallet, have a flat tire, need a locksmith resource to call, etc., use these phones.
All emergency/courtesy phones are tested monthly and calls are logged at the Welcome Center.
If you see a phone that has been damaged, please report it to Safety & Security x3201
immediately.
General Disaster Procedures
Weather Safety
In the event of a weather or lock down emergency, you will be instructed to assemble in a safer
area inside your building if needed. Move to that area quickly and wait for further information.
Gathering locations for the Eye Institute during storm situations are the vision rehabilitation suite
and the vision training room on the first floor of the Eye Institute.
Fire Safety
The campus is equipped with a city-approved fire protection and alert system. If there is a fire in
your building, calmly find the nearest “Zone Fire Alarm Pull Station” and pull to alert Security,
the Fire Department, and all other occupants of the building. In addition to the audible alarm
buzzer, the alarms are also equipped with visual strobe laser lights to assist evacuees to find the
closest exit from the building. The moment the Fire Pull Stations are activated, the call is sent
directly to the Fire Department, but it may also be beneficial to have additional people call 911.
In the event of a fire alert, and/or fire drills, everyone in the building or area is to evacuate
immediately in a quick, safe, and orderly manner. Be observant for signals that the alarm was
pulled for reasons other than a fire. As a general rule, please evacuate to the parking lots furthest
away as possible, or in an open area as far away from the building as possible. Avoid driveways
and keep clear of the fire lanes. The full cooperation of faculty and staff during evacuation is
required. Faculty are charged with final search and security of their assigned work area. The
Clinic Manager is charged with final search and security of the optical area, reception and lobby
area. Any employee who fails to evacuate during a fire alarm will be subject to action by MWU
and local authorities.
After arriving in your assigned area, make sure everyone is accounted for from your department.
If someone is missing, report that person to a security officer or member of the emergency
response team. Safety & Security and Campus Facilities will take responsibility to assure that
everyone is evacuated.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 53 of 95
Specific Evacuation Routes from the Second Floor:
The “A” and “B” examination pods on the south side and classroom occupants will evacuate
through the exterior stair on the south side of the building to the parking garage or surface
parking adjacent to the multispecialty building. The “C” and “D” examination pods on the north
side of the building and occupants of the specialized testing area will evacuate through the north
exterior stairway to the far north end of the tranquility garden.
Specific Evacuation Routes from the First Floor:
Occupants of the optical, reception area, lobby, billing office and administrative suite will exit
through the front entrance to the parking garage. Occupants of the first floor north pod,
conference room and the surgical suite will exit through the north exterior doorway to the
tranquility garden. Occupants of the visual rehabilitation suite, vision training area, pediatric
examination area and sport vision area will exit through the south exterior door to the parking
area.
Violence or Suspicious Behavior
If someone on campus becomes violent or appears suspicious, call Security immediately at
x3201 and get everyone out of the area. If you observe a change in behavior in a co-worker, such
as a marked increase in stress or agitation, that causes you concern please call Human Resources
at x3208. If you are uneasy about the behavior or emotional state of a student, please contact the
Office of Student Services at x3210. If there is an unexpected threat to the health or safety of our
students and employees, take the following steps to lock down the campus.
Lock Down Instructions
 Call 911 if you discover a threat, and if possible, call Campus Safety and Security at 623572-3201. Additionally, there is a panic button located at the patient services desk in the
reception area of the Eye Institute, and also worn by the clinic manager. All faculty and
staff of the Eye Institute will receive instructions on its appropriate use during their
orientation to the building.
o Notify those around you as quickly as possible.
o Do not attempt to engage the perpetrator(s)

Move to a location within the building that has a lockable door and lock it; or
o Use a door wedge to secure door from inside
o Stack furniture in front of the door

Hide, get out of sight
o Get away from windows, doors, outer walls
o Crouch down in areas that are out of sight
o Close, cover or lock if possible all windows

Be quiet, remain calm and do not draw attention to yourself
o Turn off audio equipment
o Put cell phone on vibrate
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 54 of 95
o Listen carefully for instructions broadcasted via the internal/external emergency
broadcast system

During a “lockdown”, do not exit the building if a fire alarm sounds unless
o You have reason to believe that there really is a fire in the building
o You have been advised by a recognized emergency responder to evacuate

Do not exit the building unless Campus Safety and Security or other recognizable law
enforcement has given the “all clear”

What to do if caught outside between buildings
o Hide-find cover
o Run-get away from area
o Fight-as a last option, very dangerous and not recommended
o If caught-do not fight back, obey all commands and avoid eye contact
Bomb Threat or Suspicious Objects
Everyone in the building or area is to evacuate immediately in a quick, safe, and orderly manner.
As a general rule, please evacuate to the parking lots furthest away as possible, or in an open area
as far away from the building as possible. Avoid driveways and keep clear of the fire lanes. The
full cooperation of faculty and staff during evacuation is required. Follow the evacuation routes
described above. Any employee who fails to evacuate during a fire alarm will be subject to
action by MWU and local authorities.
After arriving in your assigned area, make sure everyone is accounted for from your department.
If someone is missing, report that person to a Security officer or member of the ERT. Safety &
Security and Campus Facilities will take responsibility to assure that everyone is evacuated.
Emergency Call 911 and x3201
MWU Safety & Security: 623/572-3201
Campus Facilities: 623/572-3307
Employee Assistance Program: 1-800/554-6931
Suicidal Thoughts Impact (24-hour line): 480/784-1500
Student Counselor: 623/572-3629
Student Services: 623/572-3210
Human Resources: 623/572-3263
Media Relations:
623/572-3400 (President’s Office)
623/572-3291 (Vice President of University Relations)
623/572-3310 (Manager of Communications)
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 55 of 95
Universal Precautions and Exposure Control Plan
The following exposure control plan is the Occupational Safety and Health Administration
Standard; it is adopted without change.
Introduction
On December 6, 1991, the Occupational Safety and Health Administration (OSHA) promulgated
a final rule entitled “Occupational Exposure to Blood Borne Pathogens”. The purpose of the
standard is to eliminate or minimize occupational exposure to the Hepatitis B virus (HBV), the
Hepatitis C virus (HCV), the Human Immunodeficiency Virus (HIV), and other blood borne
pathogens.
The risk of exposure to blood borne pathogens by optometry clinic personnel is low except as it
pertains to the use of sharp items (i.e., needles). Situations may arise in which the risk of
exposure is increased such as when a patient vomits or experiences a bloody nose, the examiner
has breaks or cuts in the skin, or emergency first aid is administered. Even though most
optometrists are not generally at high risk, an awareness of high risk situations, the mechanisms
of exposure, the availability of personal protective equipment, and what to do if exposure occurs,
among other issues, is imperative.
Definition of Exposure Incident
An exposure incident occurs when a person has contact with potentially infectious materials that
can cause the transmission of disease. The three recognized modes of workplace transmission of
blood borne pathogens that require medical treatment are:
1. Parenteral Exposure: Piercing, puncturing or cutting the skin with potentiallycontaminated sharp items. Examples include needle sticks, human bites, or cuts with broken
glass.
2. Exposure to Non-Intact Skin: Contact of potentially infectious material with existing cuts,
rashes, abrasions or other breaks in the skin.
3. Mucous Membrane Exposure: Splashing or spraying of potentially infectious materials
into unprotected eyes, nose or mouth.
What to Do In the Event of an Exposure Incident
Exposure incidents require written reporting and medical attention. The following protocol
(Center for Disease Control document Exposure to Blood - What Health-Care Workers Need to
Know) should be followed when an exposure incident occurs:





Wash the exposed area immediately and thoroughly.
Flush splashes to the nose, mouth, or skin with water.
Irrigate eyes with clean water, saline, or sterile irrigants.
Remove soaked clothing, wash skin and put on clean, dry clothing.
No scientific evidence shows that using antiseptics or squeezing the wound will reduce
the risk of transmission of a blood borne pathogen. Using a caustic agent such as bleach
is not recommended.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 56 of 95

Go to an emergency department for immediate care. The facilities located near the Eye
Institute include:
Arrowhead Community Hospital
18701 N 67th Ave, Glendale, AZ
(623) 561-1000
Banner Thunderbird Medical Center
5555 W Thunderbird Rd, Glendale, AZ
(602) 865-5555
John C Lincoln Deer Valley Hospital
19829 N 27th Ave, Phoenix, AZ
(623) 879-6100
In the event of exposure to blood or body fluids, the following procedure shall be followed in the
clinic in which exposure occurred
 Wash the exposed area immediately and thoroughly. Flush splashes to the nose, mouth,
or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Remove
soaked clothing, wash skin and put on clean, dry clothing. Do not use antiseptics or
squeeze the wound as there is no scientific evidence that this limits exposure or risk.
 Instruments that have been exposed to the blood or body fluids of anyone but the patient
will be removed from the treatment area and discarded (if disposable) as a biohazard, or,
if it is a multi-use device, the instrument will be returned for sterilization.
 If the exposure occurs during the course of patient care, the patient is to be stabilized as
quickly as possible. The exposed health care worker may arrange to have the procedure
completed by another health care worker.
 Supervising clinical faculty is to be notified in the case of a student exposure. In the case
of staff, physician/health care provider, or visitor exposure, the nursing supervisor or
medical director of the involved clinic is to be notified.
 Working with the supervising clinical faculty and/or the nursing supervisor or clinic
director, the exposure is discussed with the source patient or their legal guardian, and
baseline testing will be requested.
 The supervisory clinical faculty or clinic director will contact the MWU Multispecialty
Clinic Family Medicine/Primary Care Clinic and discuss the exposure with a physician or
physician assistant available in the clinic. In the event that no physician or physician
assistant is available in the clinic, the on-call physician will be contacted for further
recommendations.
The following procedure will be followed in the MWU Multispecialty Clinic Family Medicine
Clinic
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 57 of 95





With MWU Multispecialty Clinic physician’s approval and orders, the exposed person
and the source patient will proceed to the MWU Multispecialty Clinic for the blood work
and consultation.
The exposed person and the source patient will both be registered and fill out appropriate
intake paperwork as patients of the MWU Multispecialty Clinic.
The source patient will be asked to complete the attached questionnaire to assist in
assessment of risk for an undiagnosed blood borne pathogen infection, and a standard
release of information to allow release of the blood results to the exposed person. All
documents created (including questionnaire, release of records, consent, and test results)
will be filed in the MWU Multispecialty Clinic electronic health record (E H R) created
for that individual. All E H R and scanned records will be handled by the standard
HIPAA privacy protocol.
The exposed person will be required to fill out a Quality Assurance Occurrence Report
Form which will be kept in the Risk Management Office.
The following laboratory testing will be done on the day of exposure:
Exposed Person
Hepatitis B Surface Ab and Ag
HIV
ALT
Source Patient
Hepatitis B Surface Ag
HIV (viral load if known to be HIV
positive)
Anti-Hepatitis C Virus Ab
 If the source patient did not have an exposure to the exposed person’s blood or body fluid
he/she has no further need for follow up. If he/she did have exposure to the exposed
person’s blood, the source patient will be offered the same counseling as below regarding
risk and the same testing at the recommended interval.
 The covering physician or physician assistant in the MWU Multispecialty Clinic will
provide optional recommendations to the exposed person in regard to their risk of
contracting Hepatitis B, Hepatitis C, or HIV and the preventive measures that may be
available to him/her, using the CDC guidelines for prophylaxis. This should be done within
24 hours of the exposure. If this service cannot be offered within 24 hours of exposure, the
exposed person should be referred to an emergency room or urgent care clinic.
 If the exposed person chooses to take the HIV post-exposure prophylaxis, this must be
started within the first day after exposure, preferably within hours.
 If there is a risk of Hepatitis B, as in the situation in which the exposed person is a
Hepatitis B Surface Antibody non-responder, the exposed person should be offered
Hepatitis B immune globulin (HGiG). If this is not available in the MWU Multispecialty
Clinic, an attempt will be made to send the exposed person to a facility where HGiG is
available.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 58 of 95
 The exposed person will be asked to return on the following schedule for lab work after
the first blood draw:
Time After Exposure
6 weeks
12 weeks
6 months

Testing
HIV
Hepatitis B Surface Ag (if previously
negative to HBV-Ab)
HIV
HIV
Hepatitis B Surface Ag (if previously
negative to HBV-Ab)
Hepatitis B Surface Ab (if previously
negative to HBV-Ab)
Anti-HCV
ALT
Positive results will result in appropriate care or referral to another physician for further
care.
Billing for medical care and laboratory testing associated with an exposure will be submitted to
the exposed person’s insurance carrier, in the case of a student, staff, or faculty. Any out-ofpocket costs will be submitted to Midwestern University Risk Management for payment.
Charges generated for medical services provided to the source patient or a visitor or patient who
has experienced and exposure in MWU clinic will be submitted to the Midwestern University
Department of Risk Management. (The Department of Risk Management will determine
whether submitted bills will be forwarded to the involved college.)
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 59 of 95
Report the exposure
Fill out the Source Patient Accidental Exposure Questionnaire following the protocol of the Eye
Institute. Immediately notify the attending optometrist and the Office of the Assistant Dean of
Clinical Education. Within 5 days, students shall send a copy of the Source Patient Accidental
Exposure Questionnaire and treatment received from the emergency department to their
attending optometrist and the Office of the Assistant Dean of Clinical Education. When making
out an injury report for an exposure incident, the student and/or preceptor must give the name of
the source individual and medical record number, if known or feasible. If an exposure occurs,
the following information should be recorded in the student’s confidential medical record:




Date and time of exposure
Job duty being performed by student at the time of the exposure
Whether protective equipment (gowns, gloves, masks, protective eyewear), or
engineering controls were used (i.e., recapping device or a needle disposal device or
mechanical pipette);
Details of exposure, including amount and type of fluid or material, and severity (e.g.,
depth of percutaneous exposure and whether fluid was injected; extent and duration of
skin or mucous membrane contact)
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 60 of 95

Description of source material, including Human Immunodeficiency Virus (HIV),
Hepatitis B virus(HBV), Hepatitis C virus(HCV) status, if known. In the event the
source individual is a dialysis patient, a current HBs-Ag report should be used.
Student Consent
The consent of the student must be given before collection of their blood and before any
serologic testing can be done.
Source Individual
The source individual is defined as any individual whose blood or other potentially infectious
materials may be a source of exposure to the health care worker. Arizona statutes state “when a
health care provider or employee of a health care facility is involved in an accidental direct skin
or mucous membrane contact with the blood or body fluids of an individual which is of a nature
that may transmit HIV, written informed consent of the source individual (patient) to perform an
HIV test is not required.” The source individual should be identified by the student. Situations
when it is not feasible to identify the source individual include incidents of needle sticks or cuts
from sharps of unknown sources, e.g., unmarked needle or blood sample. The source individual
should be tested for hepatitis B, hepatitis C, and HIV in accordance with the directives of the
rotation site where the exposure occurred.
Sources of Blood Borne Infections
Certain human-source fluids and materials are likely carriers of infectious viruses if the host is
infected. A list of the most likely infectious waste materials follows:
 Amniotic fluid
 Blood
 Cerebrospinal fluid
 Pericardial fluid
 Peritoneal fluid
 Pleural fluid
 Semen
 Synovial fluid
 Unfixed human body tissue (other than intact skin)
 Vaginal secretion
Other body fluids are believed to possess little risk for carrying and transmitting pathogenic
viruses. The following are not included as sources of blood borne pathogens (unless they contain
blood):
• Feces
• Nasal secretions
• Saliva (except in dental treatment)
• Sputum
• Sweat
• Tears
• Urine
• Vomitus
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 61 of 95
Personal Protective Equipment
Personal Protective Equipment (PPE) includes items worn by an employee to provide a barrier
between the worker and contaminated materials. PPE will be supplied by the employer at no
cost to faculty, staff, and students. Appropriate sizes and types of equipment will be provided in
the location where they are to be used. Potentially contaminated PPE must be removed before
leaving the area where it is used. Examples of the type of PPE used and some of their
characteristics are as follows:
Gloves
 Gloves are required when manual contact is initiated with potentially infectious materials
such as blood.
 Gloves must be appropriate for the task.
 Gloves must be available in appropriate sizes and in hypo-allergenic (non-latex) versions.
 Gloves are to be considered single use devices, and properly disposed of as hazardous
waste after use.
Eye and Face Protection
 Eye and face protection is required when danger of splashing or spraying of infectious
materials is anticipated.
 Safety glasses are the minimum protection. Face shields and surgical-type masks may be
required.
Clothing
 Fluid-resistant clothing must be worn if there is potential for splashing and soak through.
 All clothing (lab coats, scrubs) that is potentially contaminated with blood borne
pathogens must be laundered through the University. Hazard bags are located in the Eye
Institute central specialty testing room on the second floor and in the copy room on the
first floor. Clothing is bagged and returned to the administration area for pick up by the
University Laundry Service. No potentially contaminated clothing should be taken home
for cleaning.
Cardio-Pulmonary Resuscitation and Resuscitation Equipment
Cardio-pulmonary resuscitation (CPR) training, PPE fitting and automated external defibrillator
(AED) training are required for employees whose job includes emergency treatment and direct
patient care.
 One-way masks are required for mouth-to-mouth resuscitation.
Warning Signs and Labels
Bio hazardous warning signs and labels are used to notify all persons of the presence of
potentially infectious materials. For blood borne pathogens these signs and labels are required to
be fluorescent orange or orange-red with words and symbols in a contrasting color.
Bio hazardous labels are required for the following situations:
 Bio waste containers
 Refrigerators and freezers used to store blood or other infectious materials
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 62 of 95


Containers for storing, transporting, or shipping blood or other infectious materials
Contaminated equipment requiring handling for service, repair or shipping
Work Practice Controls
Work practice controls involve altering the way a task is performed to reduce or eliminate
exposure to potentially infectious materials. The MWU Eye Institute adopted the following
work practice controls:






Recapping of needles is prohibited. Dispose of all needles in an appropriate sharps
container.
Hand washing after contact with potentially infectious materials is required.
Eating, drinking and like activities in areas where potentially infectious materials are
used or stored is prohibited.
Methods that minimize splashing or spraying of potentially infectious materials must
always be used.
Absorbent coverings for countertops and equipment to contain spills or splashes and to
facilitate easier cleanup must be used when potentially infectious materials are present.
All potential exposure incidents must be reported immediately to the clinic consultant and
the Midwestern University Risk Management Office.
Housekeeping, Decontamination and Spill Cleanup
All work areas where potentially infectious materials are used must be maintained in a clean and
sanitary condition.
If a spill of a potentially infectious material or bodily fluid occurs, the Environmental Health and
Safety Department should be contacted at extension 3201. Under no circumstances should any
potentially infectious materials or bodily fluids be handled except by appropriate personnel.
Regulated and Other Infectious Waste
Regulated waste is waste that is capable of transmitting disease to those handling it. Examples
of regulated waste, according to Arizona State regulation
http://www.ica.state.az.us/divisions/osha/safety_health_compliance.html
include the following:







Liquid or semi-liquid blood or other potentially infectious materials
Contaminated items capable of releasing blood or other contaminated materials if
compressed
Items caked with dried blood or other potentially infectious materials which are capable
of releasing these materials during handling
Contaminated sharps
Human tissues
Infectious biological cultures or agents
Contaminated animal carcasses, body parts and bedding
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 63 of 95
It is also recommended that the following materials be included in the infectious waste stream:

Potentially contaminated disposable gloves

Potentially contaminated surface coverings, equipment coverings, and protective
coverings

Bandages that have contacted blood or other body fluids
Containment and Disposal of Infectious Waste
Infectious waste must be divided into two waste streams: non-sharp and sharp items. Non-sharp
items, including disposable gloves, gowns and barrier materials, are disposed of in an infectious
waste bag. Sharp items are those that are sharp in their original form or can become sharp on
breaking or bending. Sharp items are disposed of in puncture-resistant sharp containers,
typically constructed of heavy-duty plastics. Sharps include the following:






Glassware
Needles
Pasteur pipettes
Rigid plastic pipettes
Scalpels
Syringes
Infectious waste must be treated to eliminate its infectious properties prior to disposal. The
primary treatment for infectious waste is autoclaving, a heat treatment for inactivating infectious
materials. If there is an autoclave within the department or building, infectious waste can be
treated on-site and marked “treated”. Once infectious waste has been properly autoclaved and
marked as such, it can be disposed as ordinary trash.
If there is no autoclave available for use within the department or building, contact
Environmental Health and Safety for information on treatment and disposal of infectious waste.
An autoclave will be located on the first floor of the Eye Institute adjacent to the surgical suite.
Although human blood is listed as a regulated infectious waste, it is allowed to be disposed in
sink or sewer drains as long as it is done carefully without splashing and is thoroughly washed
down the drain with water. The sewage system and treatment plant provide appropriate
treatment for this material.
Clinical Disinfection Procedures
Disinfection of Goldmann Applanation Tonometer Prisms and Gonioscopy Lenses
Goldmann prisms are the property of each student. It is the student’s responsibility to ensure that
the prism has been properly disinfected prior to each use.
Disinfection of the tonometer prisms includes:
 The tonometer prism should be disinfected between patients with 3% hydrogen peroxide
solution or Dakin’s solution for ten minutes.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 64 of 95


The tonometer prism should be rinsed with sterile saline solution.
The prism should be air dried for two minutes or wiped with lint free tissue.
Trial Contact Lens Disinfection
 If infectious risk is present sterile or non-sterile examination gloves shall be worn and
hands washed.
 All trial contact lenses, including hard, gas permeable and soft lenses, are to be
disinfected using products effective against the HIV virus as recommended by the Center
for Disease Control (CDC) and appropriate Eye Institute committee. This excludes
disposable soft contact lenses.
 All contact lens vials are to be emptied of the used saline, filled with fresh 3% hydrogen
peroxide and left for 10 minutes, emptied and rinsed well with saline solution (not water)
and refilled with fresh saline before inserting the disinfected lens. Contact lens cases
used in-office should be discarded after each use or given to the patient for whose lenses
it was utilized.
Surgical Instruments Disinfection
Following usage the metal anterior segment surgical instruments are to be soaked for 10 minutes
in fresh 3% hydrogen peroxide solution in an appropriate container. The Alger brush tip must be
disengaged prior to sterilization.
Clinical Precautions and Procedures
Clinicians are not to handle any body fluid spills other than those encountered in the course of a
normal optometric examination (e.g. tears). If a body fluid spill occurs (e.g. vomit, blood, etc.),
a faculty member or supervisor should be contacted immediately. The consultant or supervisor
will have the body fluid spill removed by appropriate personnel.
 Hands should be washed with soap and water or an alcohol-based hand rub should be
used immediately before and after performing a procedure that results in patient contact.
This step should be performed whether or not gloves are worn.
 A sterile cotton-tipped applicator should be used to examine a patient with a red eye.
 Gloves should be worn when coming into contact with tears of those patients with
potentially contagious conditions. Gloves must be worn when cuts, scratches or other
dermatologic lesions are present on the hands of the clinician. Hands must be washed
after putting the gloves on to avoid powder contamination of any surfaces.
 If a patient appears ill and it is believed body fluid spills such as vomiting may occur, the
patient must be rescheduled.
 If the clinician is ill with a potentially contagious condition such as a cold or the flu, it is
recommended that they refrain from patient care.
 Disposable surgical masks are available for use. The use of a mask during patient care is
strongly encouraged in cases where the clinician or the patient might harbor a potentially
contagious condition.
 If epidemic keratoconjunctivitis or other suspected contagious conditions are present,
examination rooms must be thoroughly disinfected prior to examining another patient.
Disinfection should include ALL surfaces touched by the clinician or the patient and
cleaned with Dakin’s solution or effective equivalent. Disinfection solution can be
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 65 of 95
obtained from the central equipment room of the Eye Institute.
examination room has a spray disinfection solution in the cabinet.
Additionally, each
Laser Safety Sheets
The following information pertains to the Diode Laser.
• The Diode Laser is a Class 4 laser.
• No laser hazard is present if the instrument is turned off.
• Class 4 lasers can damage the eyes via direct or reflected exposure (i.e. walls, mirrors,
instruments, etc.).
• A warning sign is needed when the laser is in use.
• Except for the patient and the operator of the laser, personal protective equipment (laser
safety glasses) must be worn by all persons in or entering the laser room while the laser is
in use. Laser safety glasses are found in the Eye Institute central equipment room and
within the laser procedure room.
• The risk of injury is minimal when laser safety procedures are followed.
Material Safety Data Sheets
Material Safety Data Sheets (MSDS) are documents which provide workers and emergency
personnel with the proper procedures for handling or responding to exposure to particular
substances. A MSDS summarizes information such as the physical properties of the substance,
toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, and spill or
leak procedures. Occupational Safety and Health Administration (OSHA) mandated MSDS's for
hazardous materials effective May 26, 1986. MSDS's are meant for:



Employees who may be occupationally exposed to a hazardous material at work.
Employers who need to know the proper methods for storage and handling hazardous
material at work.
Emergency responders and medical personnel who need to know how to handle and treat
individuals exposed to hazardous materials.
MSDS’s are kept on file at the Eye Institute in the Clinic Manager’s Office and are clearly
labeled and visible for quick reference.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 66 of 95
SAFETY PROCEDURES FOR EYE INSTITUTE PATIENT CARE
Adverse Drug Reactions
In the event a patient develops a clinically significant drug induced side effect from systemic
medications or ocular medications, a modification of the treatment plan will be implemented and
documented. A plan for patient follow up should be made as indicated.
In the event a patient develops a clinically significant side effect from Rapid Sequence
Fluorescein Angiography, immediate steps should be taken to alleviate the patient’s symptoms.
Diphenhydramine and Epi-pens® are available in the pharmacy room.
Abuse or Neglect Reporting
Abuse can occur with a child or a vulnerable adult. A vulnerable adult is an individual who is
eighteen years of age or older and who is unable to protect himself from abuse, neglect or
exploitation by others because of a physical or mental impairment. A vulnerable adult includes
an incapacitated person. Abuse can take many forms: intentional infliction of physical harm,
injury caused by negligent acts or omissions, unreasonable confinement, sexual abuse, or assault
(A.R.S. § 46-451)
“Abuse of a child is defined as the infliction or allowing of physical injury, impairment of
bodily function or disfigurement or the infliction of or allowing another person to cause serious
emotional damage as evidenced by severe anxiety, depression, withdrawal or untoward
aggressive behavior and which emotional damage is diagnosed by a medical doctor or
psychologist and is caused by the acts or omissions of an individual having care, custody and
control of a child.” (A.R.S. § 8-201). Physical abuse includes non-accidental physical injuries
such as bruises, broken bones, cuts or other injuries. Neglect occurs when children are not given
necessary care for illness or injury, leaving young children unsupervised or alone, locked in or
out of the house, or without adequate clothing, food or shelter.
Arizona law requires optometrists and other health care professionals, who reasonably believe
that a minor is or has been the victim of physical injury, abuse, child abuse or neglect, or has
received a non-accidental injury, to immediately report their concerns to Child Protective
Services (CPS) or local law enforcement (A.R.S. §13-3620).
Pursuant to A.R.S. §13-3620.O, failure to report or false reporting is a class 1 misdemeanor. If
the failure to report involves a reportable offense as defined and listed in A.R.S. § 13-3620(P)(4),
the person who violates this mandate is guilty of a class 6 felony.
Reports of child abuse shall be made immediately by telephone or in person, and shall be
followed by a written report within seventy-two hours (A.R.S. §13-3620.D). The reports should
contain:
1. The names and addresses of the suspected victim minor and the minor’s parents or the
person having control or custody of the minor, if known.
2. The minor’s age and the nature and extent of the minor’s abuse, physical injury or
neglect, including any evidence of previous abuse, child abuse, physical injury or neglect.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 67 of 95
3. Any other information that the person believes might be helpful in establishing the cause
of the abuse, physical injury or neglect.
Abuse of a vulnerable adult under circumstances likely to produce death or serious physical
injury, includes intentional infliction of physical harm, injury caused by criminally negligent acts
or omissions, unlawful imprisonment, and sexual abuse or sexual assault (A.R.S. §13-3623).
Abuse involves situations where the adult’s safety or well-being is being compromised by their
inability to take care of their basic needs, their medical needs, their finances, their home
environment or their personal hygiene. In other cases, vulnerable adults may be the victims of
financial exploitation or physical, emotional or sexual harm.
Arizona Revised Statute §46-454 mandates that an optometrist or other health care professional,
who has a reasonable basis to believe that abuse or neglect of the adult and/or the adult’s
property has occurred, shall immediately report such reasonable basis to a protective service
worker in person or by telephone, followed by a written report mailed or delivered within fortyeight hours or on the next working day if the 48 hours expire on a weekend or holiday.
The report shall contain:
1. The names and addresses of the adult and any persons having control or custody of the
adult, if known.
2. The adult's age and the nature and extent of the adult's vulnerability.
3. The nature and extent of the adult's injuries, physical neglect, or exploitation of the adult's
property.
4. Any other information that might be helpful in establishing the cause of the adult's injuries
or physical neglect or of the exploitation of the adult's property.
The following are contact numbers to report suspected child and vulnerable adult abuse:
Arizona Child Abuse Hotline- 1-888-SOS-CHILD (1-888-767-2445)
Child Protective Services
(CPS)
Arizona Adult
Services (APS)
Protective 1-877-SOS-ADULT (1-877-767-2385) or online at
https://www.azdes.gov/landingforms.aspx?form=7704
Other resources:
ALCOHOL
&
OTHER 602-264-1341
DRUG ABUSE
Alcoholics
AnonymousPhoenix
or
ARIZONA LONG TERM 602-417-6600,
http://www.azahcccs.gov/applicants/application/ALTCS.aspx
CARE SYSTEM (ALTCS)
Phoenix ALTCS Office
DOMESTIC VIOLENCE
1−800−799−SAFE(7233), 1−800−787−3224 (TTY) or
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 68 of 95
National Domestic Violence http://www.thehotline.org/
Hotline
LAW ENFORCEMENT
ATTORNEY GENERAL
Office of Victim Services
- 866-742-4911/complaints 602-542-8409
Phoenix 602-542-4911
1-800-MEDICARE (1-800-633-4227) or www.medicare.gov
MEDICARE
Federal
Health
Insurance
Program Part A & B National
SUBSTANCE ABUSE AND 800- 487-4889 or http://www.samhsa.gov/prevention/
MENTAL
HEALTH
SERVICES
ADMINISTRATION
National Mental Health Info
SEXUAL
ASSAULT
& EMPACT Sexual Assault Hotline (480) 736-4949
Crisis Hotline (602) 222-9444 or (800) 631-1314
ABUSE
Arizona
Sexual
Assault http://www.arizonasexualassaultnetwork.org/
Network (AZSAN)
Be Safe / Be Smart Crime Prevention
Following safety precautions can decrease crime and your risk of becoming a victim.
 Lock your office doors when unoccupied. Always keep personal belongings in locked
drawers, cabinet or lockers.
 Do not leave messages on your door indicating when you are away and when you will
return. This information can be left with the Clinic Manager, the Faculty of the Day, or
the Assistant Dean of Clinical Education.
 If someone asks to use your office phone, direct them to the front lobby for a general use
phone.
 Do not put your office location or address on your key ring.
 Do not put keys in hiding places.
 Report suspicious persons to campus security.
 Call for campus security for escort services if you are working after clinic hours.
Campus Safety & Security at x3201, or 623-572-3201
City Emergent Services Call 911
For non-emergent services the following numbers can be used:
Glendale Police
623-930-3000
Glendale Fire
623-931-5600
Glendale Paramedics
623-931-5600
Poison Center
602-253-3334
Hazardous Material Hotline
623-930-3410
Health Department, Maricopa County
623-344-6700
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 69 of 95
Imaging Orders
For imaging not available within our campus clinics (MRI, CT, and X-ray) pre-scheduling
questionnaires are provided by the referral service. Questionnaires and location maps are in the
specialized testing area. For assistance contact the Clinic Manager or the Lead Ophthalmic
Techinician.
Laboratory Testing
For those patients who are eligible to make use of Sonoran Laboratory, a phlebotomist is
available in the MWU Multispecialty Clinic, for blood draws.
Microbiology Cultures
Culture materials, transport media for viruses Chlamydia, bacterial transport material such as
agar plates, broth, and slides for stains can be obtained in the pharmacy room. Label any
cultures or stains appropriately with patient name, clinic number and site of sample. Remember
to take two samples if you want identification and culture and sensitivity. All cultures should be
placed in a biohazard bag and given to the Clinic Manager for transport to the lab.
Ocular Emergencies
All ocular emergencies should be seen on the same day as first contact. Appropriate referral
should be made as soon as it is known to be warranted by the patient’s ocular condition. If an
emergent walk-in patient presents to the front desk, triage should take place as soon as the Lead
Faculty of the Day is notified.
Pharmaceutical Samples Policy
Pharmaceutical samples will be stored in the pharmacy room. All samples shall be documented
and appropriate patient education will accompany any dispensed samples. As a standard
protocol, whenever a sample is given, appropriate student education will be given regarding drug
selection and rationale.
Prescribing Controlled Non-Narcotic Medications
Electronic prescriptions will be utilized at all times if possible. Written prescriptions should be
avoided.
Prescribing Narcotic Medications
Electronic prescriptions will be utilized at all times if possible. Written prescriptions should be
avoided. Narcotic medication should not be refilled after hours or on weekends without the
patient being seen by the provider at the time the prescription is given.
Sterilization and Disinfections Procedures
The autoclave is located in the surgical suite. The Lead Ophthalmic Technician will be
responsible to run the autoclave at the end of the clinical day. A tray with Cidex solution (or
equivalent) is located on the counter adjacent to the autoclave for placement of contaminated
instruments.
Therapeutic Drug Policy
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 70 of 95
Ophthalmic drugs for in clinic use only will be kept in the pharmacy room. Access to and for the
pharmacy room key can be obtained from the faculty of the day, the Assistant Dean of Clinic
Education, or the Clinic Manager. Medications removed from this location require the
signatures of the student clinician and the attending clinical optometrist and/or the faculty of the
day on the inventory sheet posted.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 71 of 95
APPENDICES
APPENDIX I - PATIENT CARE POLICIES
Clinical Services and Referrals
Clinic services include: complete primary eye care, pediatric eye evaluations, binocular vision
assessment and vision therapy, contact lens evaluation and fitting, electro-diagnostic testing and
reporting, low vision evaluation and management, ocular disease evaluation treatment and
management, sports vision evaluation and therapy, and full optical services.
Release of Information Policy
See HIPAA section
Release of Prescription Policy
Spectacle prescriptions will be released to each patient at the completion of the examination and
when fees are paid. Additional copies may be released with the notation of the date of the
examination and the name of the examiner and clearly marked, “DUPLICATE”. Copies of
spectacle prescriptions that are older than one year shall be clearly marked “EXPIRED”.
Contact lens prescriptions will be released when all fees are paid and appropriate follow-up
associated with the fitting has been completed.
The Arizona Practice Act has prescription standards that are included in their entirety below.
Optometric Prescription Standards; Release to Patients R4-21-306.
A. When a licensee completes an eye examination and generates an optometric prescription, the
licensee shall provide the patient with a copy of the optometric prescription without charging
a fee other than the examination fee.
B. A licensee shall ensure that an optometric prescription written by the licensee includes:
1. For ophthalmic lenses other than contact lenses:
a. Name of the patient;
b. Refractive power of the lenses;
c. Interpupillary distance;
d. Printed name, office address, telephone number, and signature of the licensee; and
e. Date of the examination and expiration date of the prescription;
2. For contact lenses, including plano lenses:
a. Name of the patient;
b. For a patient who has not completed a trial period appropriate under the
circumstances and desires to have a prescription, the information required for the
patient to purchase trial lenses at another optical establishment or location;
c. For a patient who has completed a trial period appropriate under the circumstances
for the lenses prescribed, all information necessary to reproduce the contact lenses
accurately;
d. Printed name, office address, telephone number, license number, and signature of the
licensee;
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 72 of 95
e. Date of the examination and the issue and expiration date of the prescription; and
f. Information regarding the prescribed contact lenses:
i. Refractive power;
ii. Base curve or other appropriate designation;
iii. Diameter, if appropriate;
iv. Tint, if applicable;
v. Material, manufacturer, or both; and
vi. In the case of private-label contact lenses, manufacturer, trade name, and, if
applicable, trade name of equivalent brand name; and
3. For pharmaceutical agents:
a. Name and address of the patient;
b. Date the prescription is issued;
c. Name, strength, and quantity of the pharmaceutical agent prescribed;
d. Directions for use of the pharmaceutical agent prescribed;
e. Name, office address, and telephone number of the prescribing licensee;
f. DEA number of the prescribing licensee;
g. Two adjacent signature lines with the following printed words:
i. “Dispense as written” under the left signature line, and
ii. “Substitution permissible” under the right signature line; and
h. Original signature of the prescribing licensee on one of the signature lines; and
4. Additional information that the licensee considers necessary.
C. A licensee who dispenses or directs the dispensing of ophthalmic materials shall ensure that a
prescription is filled accurately.
D. A licensee shall be available to verify that a prescription written by the licensee, but filled by
another provider of ophthalmic goods, is accurately filled. The licensee may charge a fee for
verifying the accuracy or quality of ophthalmic goods dispensed by another provider.
Letter Writing Guidelines
When information is needed for letter writing, the patient’s electronic health record (EHR)
should be sourced. No information from the patient’s EHR is to be photocopied. It is Eye
Institute policy that any identifiable information may only be stored on University-owned
computers. No Faculty, Staff or student will store or access any protected information either
remotely or from within the college via any computer system that was not specifically purchased
by the University. This includes home access, any storage media, or personally owned laptop.
Remote access for clinical faculty is provided by password and access given by Information
Technology Services. Please review the Remote Access policy for greater detail.
Letters will be written from the Compulink® system and saved to the patient‘s EHR. The
Clinical Faculty preceptor will review the correspondence, approve the content and edit it, if
indicated. Hard copy can then be printed, signed and mailed.
Letters should be completed at the end of the clinical session within which the patient was
examined.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 73 of 95
Patient Complaint Procedure
A patient may call, write, or present in person to the Clinic Manager or Assistant Dean of
Clinical Affairs an issue or complaint relating to care received at the Eye Institute or the handling
of Protected Health Information (“PHI”).
In this event of a complaint, the Assistant Dean of Clinical Affairs will notify the Dean, Arizona
College of Optometry, the Vice-President and Chief Academic Officer, the Vice-President for
Finance, Senior Vice-President and Chief Financial Officer, the Executive Vice-President and
Chief Operating Officer, and the President and Chief Executive Officer of Midwestern
University.
The Assistant Dean of Clinical Affairs will review and investigate the issue or complaint raised
and make reasonable efforts to resolve the matter formally, including, when appropriate, inviting
the patient to meet in person to discuss the matter. If the complaint can be resolved by the Clinic
Manager, the complaint will be forwarded to that person to resolve. At the Assistant Dean’s
discretion, the Department of Risk Management may be contacted to assist with any
investigation. Risk Management must be notified of any matter that could reasonably result in
either a complaint being filed with the State Board of Optometry or litigation. The HIPAA
Privacy Officer should be notified regarding any concerns or complaints raised and relating to
the handling of PHI.
If a matter is not resolved within 24 hours, the Assistant Dean of Clinical Affairs should consult
with the Department of Risk Management regarding preparation of a written response to the
patient. A written response must be provided to the patient within 5 days from the date of issue
or complaint is raised.
A patient is permitted to have a non-legal representative of their choice to represent their
interests during the process. If a patient prefers representation by an attorney, Midwestern
University’s attorney must be present.
The Patient Accounts Manager will be notified of any determination by the Assistant Dean of
Clinical Affairs resulting in a refund of monies previously paid to the Midwestern University
Eye Institute.
If the complaint is elevated to the level of formal grievance, the Assistant Dean of Clinical
Affairs will refer the grievance to the most appropriate division of the University. If the
grievance concerns sexual harassment or racial discrimination, the grievance will be forwarded
to the University office of Human Resources for investigation. If the grievance concerns quality
of patient care, the Assistant Dean of Clinical Affairs will form an ad hoc medical review board
committee, whose membership will include the Assistant Dean of Clinical Affairs, the Vice
President of Clinic Operations, and at least two other clinical faculty members with no conflict of
interest. The ad hoc medical review board committee will review the complaint and the medical
record. If necessary, the ad hoc committee will collect additional information from the clinic
faculty. A written response to the complainant must be provided within 7 working days.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 74 of 95
If a mutually satisfactory resolution is not reached between the patient and the Assistant Dean of
Clinical Affairs, the matter will be referred to the Dean, College of Optometry. The Dean should
be notified of any unresolved matters within 7 days of the date the concern or complaint is
raised.
If the Dean, Arizona College of Optometry, cannot reasonably resolve the grievance within 14
days from the referral date, the Dean will notify the Vice President and Chief Academic Officer,
at whose discretion, may notify the President and Chief Executive Office of Midwestern
University.
The Assistant Dean of Clinical Affairs will send a monthly report of patient complaints and
grievances to the Dean, Arizona College of Optometry, the Vice President and Chief Academic
Officer, the Vice President for Finance, Senior Vice President and Chief Financial Officer, the
Executive Vice President and Chief Operating Officer, and the President and Chief Executive
Officer of Midwestern University.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 75 of 95
APPENDIX II - MWU CLINIC POLICIES
To view a full copy of each policy, please go to:
http://www.midwestern.edu/protected-pages/policies/arizona-eye-institute-policies.html
Accidental Blood or Other Potentially Infectious Material Exposure Policy
Authorship Policy
Breach Notification Policy
Charge Entry Timeframe Policy
Clinical Faculty Remote Access to EHR System Policy
Code of Conduct Policy
Collection Agencies Policy
Commercial Support of Continuing Education (CE) Policy
Compulink Charting Policy
Contact Lens Patient Care Policy
Credit Balances on Patient Accounts Policy
Credentialing Policy
Cross-Clinic Dismissal Policy
Daily Reconciliation of Over-the-Counter Payments Policy
Data Collection for Educational Purposes Policy
De-identification of Protected Health Information Policy
Dismissal from Clinic Due to Non-Payment Policy
Documentation and Disclosure of PHI Policy
Education of Students Regarding Interaction with Pharmaceutical and Healthcare
Equipment Industry Policy
Emergency Protocol
Gifts and Meals from the Pharmaceutical and Medical Device Industries Policy
Gifts from Patients Policy
HIPAA Annual Training for Clinic Providers and Staff Policy
HIPAA Personnel Designations Policy
Home Visit by Eye Institute Provider Policy
Identifying Patients with Financial Hardship Policy
Immunization and Tuberculosis Testing for Clinic Employees Policy
Industry-Funded Speaking Relationships Policy
Industry-Supported Fellowships and Scholarships Policy
Licensed Provider Clinic Privileging Policy
Mandatory Complementary Ocular Function and Health Examinations for the First Year
Student Policy
Minimum Necessary Use of Protected Health Information (PHI) Policy
Notice of Privacy Practices Policy
Patient and Third Party Refunds Policy
Patient Cancellation and No-Shows Policy
Patient Complaints - Policy for response timeline and notification of others
Patient Registration - Legal Name Policy
Patient Registration, Payment and Discharge Process Policy
Patient Rights Concerning PHI Policy
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
03/11/13
01/08/14
10/16/13
08/08/13
07/12/12
08/2011
11/07/12
01/22/14
05/30/12
08/22/12
08/17/10
07/22/13
10/06/10
08/17/10
11/14/12
04/03/13
08/17/10
03/21/14
01/17/13
05/09/11
01/22/14
01/27/11
06/11/13
03/21/14
01/30/12
04/02/14
06/10/11
01/22/14
01/22/14
10/16/13
12/17/10
11/16/11
10/16/13
10/11/13
08/09/13
08/22/12
12/11/08
08/17/10
03/21/14
Page 76 of 95
Payment for Patient Services by Someone Other than the Patient Policy
10/16/13
Payment Plan Policy
08/17/10
Pharmaceutical and Medical Device Purchasing Policy
01/22/14
Pharmaceutical Samples Policy
01/22/14
PHI Safeguards (Security Rule) Policy
06/19/13
Registration, Licensure, Continuing Education, Medical Liability Insurance, Board
08/01/11
Certification and other Certification Requirements Policy
Requesting Restricted Access Designation on Employee of Student Medical Records
06/10/13
Policy
Research Patients in the Eye Institute Policy
10/16/12
Responses to Social Media Reviews Policy
04/04/13
Return and Exchange Policy
01/04/12
Securing Protected Health Information (PHI) Policy
11/16/11
Security Incidents (HIPAA) Policy
10/24/12
Sensitive Information Protection Policy
05/01/12
Site Access by Medical Device Equipment and Medical Supply Company
01/22/14
Representatives Policy
Site Access by Pharmaceutical Representatives Policy
01/22/14
Small Balances Policy
08/30/12
Sponsorship of Attendance at Medical Device and Supply Companies and
01/22/14
Pharmaceutical Industry-Sponsored Educational Events Policy
Standardized Patients in the Eye Institute Policy
08/22/12
Student Vision Therapy in the Eye Institute Policy
10/16/12
Transmission/Communication of PHI Policy
10/24/12
Types of Accepted Patient Payments Policy
08/17/10
Vision Screenings and Health Fair Policy
11/08/11
Waiver and Discount of Co-Payments, Co-Insurance, and Deductibles for Patients Policy 11/07/12
Additional Links for Policies
Centralized Office of Experiential Education (COEE)
Human Resources
Office of Research and Sponsored Programs
If you have any questions about this page, please contact University Administration at 623-572-3403.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 77 of 95
APPENDIX III - QUALITY ASSESSMENT PROGRAM
The Quality Assessment Program of the Eye Institute is designed to identify, resolve, and
improve processes that could enhance patient care outcomes. Each member of the College’s
faculty, staff, and student body will participate in the recognition and acknowledgement of health
care trends and best practices. The Eye Institute Quality Assessment Program will incorporate
the following philosophical bases and actions:






The initiation of actions to improve eye care services
The internal reporting of what has been found and the actions taken
A focus on processes and systems
A non-punitive culture with minimization of individual blame or retribution for
involvement in a less than optimal area of care delivery
Organizational learning about eye care best practices
Support and sharing of knowledge from other health care organizations and programs
within the Arizona College of Optometry
The Eye Institute actively engages in safety initiatives such as hand hygiene awareness,
improvement of teamwork, appropriate responses to emergent phone calls, adverse effects from
medications, and contact lens-related infections. Compliance and standards of care are
monitored via a quarterly quality assessment program implemented by the Best Practices
Committee. The Quality Assessment Program, utilizes metrics that include (but are not limited
to) reviews of the number of patients seen, the number of patient complaints, the number of
prescriptions written, and the number of reported adverse outcomes, such as the number of
refraction rechecks. Patient satisfaction surveys are distributed for completion to patients and
their families to evaluate the clinic faculty, staff and facilities after a recent visit to the Eye
Institute. These survey results are also used in the Quality Assessment Program.
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 78 of 95
APPENDIX IV - COURSES DELIVERED IN PART OR WHOLE
WITHIN THE EYE INSTITUTE
There are several courses that will require time spent within the Eye Institute. These courses will
include the clinical science sequence, ophthalmic optics, low vision, ocular prosthetics and
electrodiagnostics. Each course director will require introduction and possibly mastery of a
specific skill set. Examples of the activities for those courses are found here.
Clinical Services I-III
EXAMPLE OPTICAL
Name
If able to aid in a spectacle order:
What was the spectacle Rx?
What was the purpose or use for the spectacle Rx?
What style of frame was chosen and why?
Take all necessary measurements.
Measure a patient for bifocals and record all necessary measurements.
Measure a patient for progressives and record all necessary measurements.
Adjustments
What was the complaint and how was it fixed? (If there is not a patient available for this, have
your partner pretend to be a patient with a complaint and use practice frames.)
Types of progressive lenses
Name 3 progressive lenses that are good for extensive computer use.
Name 3 progressive lenses that are recommended for smaller frames.
List 5 PAL symbols and identify the type of progressive lens.
Business questions
What information is required on a spectacle Rx in Arizona?
What information is required on a spectacle Rx from your home state? (List the state.)
Is there an expiration date requirement for AZ and/or your home state? If so, what is it?
What information is on a frame tag?
How do you decide on the number of frames to purchase for an optical?
What is the approximate total cost of an inventory for a private practice?
Optician Signature
PC EXAM OBSERVATION
Name
Attending Doctor Signature
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 79 of 95
Analysis of the exam
List the order of tests performed during the exam.
Did the exam flow in a smooth manner?
How could the student doctor have been more efficient?
Describe the communication between the student doctor and the patient?
Was any jargon used in communicating with patient? If so, what terms were used?
Write out how you would have presented the case to the attending doctor.
What ancillary testing, if any, was done and why?
List two things you learned from observing this exam?
1.
2.
EXAMPLE SPECIALTY TESTING
Name
Corneal Mapping
1. Questions:
a. When fitting a contact lens for keratoconus patients, why is corneal topography
beneficial?
b. Name the 3 topographers found within the MWU Eye Institute.
c. Which corneal mapping device can assess anterior chamber depth?
d. Which machine primarily maps the front surface of the cornea curvature?
e. Name two clinical situations in which topography would be useful.
Auto refractor/Ks
1. Perform manual Ks and auto Ks on your partner and compare them. Are they within
reasonable agreement (±0.75 D and ±30°)?
Manual Ks:
OD:
____________________________________________________________________
OS: ____________________________________________________________________
Auto Ks:
OD: ____________________________________________________________________
OS: ____________________________________________________________________
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 80 of 95
Fundus Camera
1. Take a fundus photos of your partner
a. Assess C/D ratios
b. Assess A/V ratios
c. Assess the macula
d. Assess an irregularities
2. Questions
a. When would you use “stereo” mode?
b. Name two conditions that you would document with fundus photos.
c. What is the smallest acceptable pupil size for a non-mydriatic camera?
Visual Fields
1. Perform a Humphrey 30-2 Sita Standard on your partner (attach results)
a. Label the following on your test results:
A. Test name
B. Reliability indices
C. Test duration
D. The eye tested
E. The Rx used
F. The test strategy
G. Raw numeric sensitivities
H. Total deviation numeric plot
I. Pattern deviation numeric plot
J. Total deviation probability plot
K. Pattern deviation probability plot
L. Glaucoma hemifield test (GHT)
M. Visual field indices
b. Was the test reliable?
c. How many fixation losses were there?
d. How long did the test take?
2. Questions:
a. What is a false negative?
b. What is a false positive?
c. What information do the total deviation plots tell you?
d. What is the mean deviation?
e. What is the pattern standard deviation?
f. What is the difference between static and kinetic visual fields?
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 81 of 95
g. What is the smallest acceptable pupil size to ensure accuracy during the Humphrey visual
field test?
h. Why is the patient’s age required data information?
i. How are fixation losses tested?
j. Why is proper patching of the eye so important?
Optical Coherence Topography (OCT)
1. Observe a technician perform an RNFL OCT and a macula OCT.
2. List 2 indications for performing each type of scan.
RNFL:
Macula:
3. Define the difference between tomography and topography.
4. What is the difference between Fourier and Spectral Domain OCT?
5. Label the layers of the retina on the macula OCT below.
Hand-held Tonometry
1. Perform at least one type of hand-held tonometry on your partner.
2. Record your measurements OD
OS
3. Name of device
Ophthalmic Technician Signature
EXAMPLE LOW VISION SERVICES
1
.
2
.
3
.
Be able to apply epidemiologic aspects of visual impairment, appropriate
terminology and classifications of visual impairment in order to communicate
with patients, the public and other health care providers.
In addition to performing a standard case history, be able to ask basic questions about
symptoms, functional difficulties, and rehabilitation goals to anticipate the level
of care that patients with visual impairment may require.
Be able to recognize functional implications, hereditary factors and prognoses of
common causes of visual impairment and explain them in language
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 82 of 95
4
.
5
.
6
.
7
.
8
.
9
.
1
0
.
1
1
.
1
2
.
1
3
.
1
4
.
1
5
.
1
6
.
1
7
.
1
understandable to patients, families and other care providers.
Be able to recognize psychological factors (e.g. depression, grief, motivation) that
may affect adjustment to vision loss and the potential for rehabilitation.
Be able to recognize pertinent social factors (e.g. social support system, education
level, vocation, physical environment) and how they may influence the
rehabilitation plan and process.
Be able to recognize significant physical and neurological co-morbidities (e.g.
Parkinson disease, stroke, dementia) that influence low vision rehabilitation and
modify evaluation strategies and rehabilitation.
Be able to perform visual acuity testing at both distance and near on patients with
visual impairment using appropriate charts (e.g. Fienbloom, ETDRS, BaileyLovie) with proper documentation (e.g. working distance, eccentric viewing,
illumination).
Be able to perform trial lens refraction and modify refractive techniques for the
patient with visual impairment (e.g. bracketing, hand held Jackson cross
cylinder).
Be able to recognize common symptoms of contrast sensitivity loss, screen for loss,
recommend basic modifications (e.g. filter, lens, lighting and environmental
options) and refer for comprehensive low vision rehabilitation when indicated.
Be able to detect scotomas of the central visual field, understand their impact on
visual acuity and visual function, and educate patients about their implications for
activities of daily living.
Understand optical principles of near low vision rehabilitation devices (e.g. hand held
magnifiers, stand magnifiers) and distance low vision rehabilitation devices (e.g.
telescope, bioptic fitting) and be able to predict magnification levels needed to
achieve patient goals.
Be able to prescribe basic optical and non-optical low vision rehabilitation devices,
provide training in their use, and refer for comprehensive low vision
rehabilitation when indicated.
Be able to recognize availability of and indications for use of adaptive technology
(e.g. video magnification, software). Be aware of the latest technology and have
the ability to train individuals in its utilization.
Be cognizant of rehabilitation strategies for visual field deficits (e.g. sighted guide
technique, orientation and mobility, visual field enhancement devices (e.g. sector
and EP prism) and equipment, scanning training).
Develop an understanding of the special considerations for examining children, the
elderly, and the multiply handicapped and educate about referral options and
potential for rehabilitation.
Understand relevant vision standards for driving, provide necessary assessment and
documentation, bioptic telescope fitting, and be able to refer for driver
evaluation/training, and medical evaluation when indicated.
Be aware of the criteria for legal blindness determination and be able to educate
patients on the basic social and legal ramifications of legal blindness certification.
Understand that the needs of patients with visual impairment may require
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 83 of 95
8
.
1
9
.
2
0
.
professional collaboration and be able to coordinate care with available
rehabilitative, educational and social service resources.
Identify governmental, private and consumer organizations that offer support and
information to individuals with visual impairment (e.g. NEI, Veterans
Administration, state rehabilitation agencies, foundations for the blind, consumer
advocacy groups and support groups).
Be familiar with third party reimbursement for low vision rehabilitation services and
materials.
EXAMPLE OCULAR PROSTHETICS
Midwestern University Eye Institute
Arizona College of Optometry
OCULAR PROSTHETIC SERVICE EVALUATION
Student
Name:
____________________
______________________
Category
Preparation
Exceptional

Satisfactory

Attending
Minimal

Faculty
Unacceptable

Name:
N/A

*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Identification of
Patient
Needs









*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Technical Skills



*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Data
Interpretation



Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 84 of 95
*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Management of
Patient
Needs







*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Communication/
Letters/Reports



*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Coding
and
Billing





*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
Professionalis
m





*COMMENTS: (Mandatory for Minimal or Unacceptable ratings)
EXAMPLE ELECTRODIAGNOSTICS
Goals of the Students Rotating in the Electrodiagnostic Clinic
1) Learn about clinical applications of electrodiagnostic tests
2) Learn the essential information that the tests provide
3) Learn to identify the kinds of patients which may need specialty testing and which tests
are most appropriate
4) Broaden your exposure to ocular pathologies.
Bring
1) A diagnostic kit, cover paddle, and one person should bring a BIO. (You can use my
lenses). You won’t need anything else so please leave the rest of your equipment in your
morning exam room or locker. (There is not enough space for 4 of us the patient and 8
suitcases of equipment.)
2) Your questions and some excitement for learning!
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 85 of 95
Check out Evaluation
1) Why did the patient present to the EDx clinic today?
2) What test(s) were preformed for your patient today?
3) What cell groups do those procedures test? (I reserve the right to ask about more tests
than just the tests that were performed that day)
4) Is there any other information you would like to know that we don’t have?
5) What is the working diagnosis of our patient? (if unknown a differential diagnostic list is
alright)
6)
What did you learn today?
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 86 of 95
APPENDIX V- INCIDENT REPORT FORM
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 87 of 95
APPENDIX VI - INTERNAL REQUEST FOR CLINICAL ROTATION
ABSENCE FORM
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 88 of 95
APPENDIX VII - EXTERNAL REQUEST FOR CLINICAL ROTATION
ABSENCE FORM
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 89 of 95
APPENDIX VIII – OPTO 1800-1830 CLINICAL SERVICES XI- XIV
MIDTERM AND FINAL GRADING FORM
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 90 of 95
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 91 of 95
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 92 of 95
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 93 of 95
APPENDIX IX - PRECEPTOR AND SITE EVALUATION
Midwestern University Arizona College of Optometry
Preceptor and Site Evaluation
4th Year OD Student
Each student must complete an evaluation of their External Rotation Site and Preceptor(s).
The evaluation is confidential and will be reviewed by the Assistant Director, Clinical Rotations and the Clinical Education
Coordinator after each External Rotation for continuous quality improvement of sites and preceptors.
A summary report will be distributed to the preceptors only after all external rotations have been completed for the academic
year, and all student names have been removed to ensure confidentiality of the responses.
5
Strongly AGREE
4
Agree
3
Satisfactory
2
Disagree
1
Strongly
DISAGREE
The preceptor was
knowledgeable about the
subject matter during
patient encounters.
The preceptor discussed
information at a suitable
level of understanding.
The preceptor
encouraged discussion
and responded
conscientiously to
questions.
The preceptor served as a
professional role model
to me.
The site provided a good
learning experience for
me.
The site was well
organized and prepared
for students.
I would recommend this
site to other students as a
good educational
experience.
In what areas is the preceptor doing well?
What improvements could be made to the optometry practice experience at this site?
Additional Comments:
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 94 of 95
APPENDIX X- PATIENT LOG
Midwestern University Eye Institute Clinic Manual (Updated 06/20/2014)
Page 95 of 95