ࡱ> EPDq` D+bjbjqPqP .::: 0       4 8($3(<42  il8O$hn~=Q    =    X    VR@   o( JZiF eX N|0x x## 8       ==5X       444d 444 444        OPTIMUM THERAPIES, LLC Job Shadow/ Observation Guidelines & Request form We expect all those who wish to shadow our therapist to follow the guidelines set below. These guidelines have been established to provide professional, quality, personalized care to our clients, community and referring physicians. How to request observation/shadowing with a therapist Complete items below, email to:  HYPERLINK "mailto:tricia@optimumtherapies.com" tricia@optimumtherapies.com click on Send a Copy Optimum Therapies will email or phone you confirmation of your day and time to observe Arrive on time. Inform the receptionist who you are and that you are here to observe from (time) to (time) today. You will be given a tour of our facility and introduced to therapist and others. First Name:  FORMTEXT       Last Name:  FORMTEXT      Phone:  FORMTEXT      Email:  FORMTEXT      Date Request for initial observation:  FORMTEXT      Time frame:  FORMTEXT       (start/end time)Will you need forms completed or letters of recommendation?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoReason for observation:  FORMTEXT       Your Goals from observation:  FORMTEXT       Area of therapy you are interested in:  FORMTEXT        Dress Code: Collared shirts, sweaters, Dress pants, Dockers, knee length or longer skirts, Dress shoes, Socks or nylons, *absolutely NO Jeans, T-shirts, Sweatshirts, flip flops, tennis shoes* Rules: Personal belonging will remain in waiting room or staff break-room. Interaction with the client, focus on condition and treatment; hold non-related questions for time when therapist is not treating client. NO food or drink in clinic or in front of patients. Remember Patient Confidentiality; what you see/hear related to clients remains in the clinJK5 6 l   # $ & ( < > @ J L ^ ` t v x پzkjhX TCJUaJjhX TCJUaJ"jhX TCJUaJmHnHuj hX TCJUaJjhX TCJUaJhX TCJaJhVbhU<0JjhU<U hU<hU<jhU<UhU<hX T5>*\ hX TCJhX T5CJ aJ hX T*JK5 6 l H X  N $i&P#$/If & F vvL^v`L$a$$a$*B+8N P vgg$i&P#$/Ifkd$$Ifl400t&\ t 6Pi0<'644 laf4 " $ . 0 2 J L ` b d n p ,.0HJfhjrtp_ jhX TCJU\aJ jVhX TCJU\aJ%jhX TCJU\aJmHnHu jhX TCJU\aJjhX TCJU\aJhX TCJ\aJjhX TCJUaJ"jhX TCJUaJmHnHujhX TCJUaJjFhX TCJUaJhX TCJaJ% 2 r vggg$i&P#$/Ifkd$$Ifl40t&\ t 6Pi0<'644 laf4 rvg$i&P#$/Ifkd$$Ifl40& t 6Pi0<'644 laf4rt02zzzzzz$i&P#$/Ifvkd>$$Ifl46&<' t 6Pi0<'644 laf4  ",.((()))*Ŵţś||z|v|h_h(UCJ\aJjh(UCJU\aJhX TUhX TCJ\aJhX T5>*CJaJhX T5>*CJaJhX TCJaJ jhX TCJU\aJ jahX TCJU\aJhX TCJ\aJ%jhX TCJU\aJmHnHujhX TCJU\aJ jhX TCJU\aJ r(C((((}xxxxxxvv & F`^vkdM $$Ifl4X&<' t 6Pi0<'644 laf4 ic. Bring any forms to be completed with you to the first meeting. Future/Subsequent observation hours to be discussed with the office manager. Confidentiality Agreement: As a student observer you may/will be exposed to confidential patient and clinic information. By signing below you agree to keep all information, people you may see or observe in the clinic confidential. Questions or concerns about this can be directed to the office manager or the therapist you are working with. Thank you. _ FORMTEXT      ___________________________ __ FORMTEXT      ___________________________ Signature Date      DATE \@ "M/d/yyyy" 11/14/2008 ()))**********>+@+B+D+8$a$*****T*V*j*l*n*x*z***********$+&+:+<+@+B+D+8޹€h?oh(FmHnHuhX TjhX TUh`"jh`"U&jp h(UhX TCJU\aJh(UCJ\aJhX TCJ\aJ%jh(UCJU\aJmHnHujh(UCJU\aJ&j h(UhX TCJU\aJ,&P/ =!"#$%  DyK tricia@optimumtherapies.comyK ^mailto:tricia@optimumtherapies.comyX;H,]ą'ctDText2tDText9$$If!vh55\#v#v\:V l40 t 6Pi0<'6,55\/ / / f4tDText7tDText6$$If!vh55\#v#v\:V l4 t 6Pi0<'6,55\/ / / / f4vDText16vDText17$$If!vh55#v#v:V l4 t 6Pi0<'6,55/ f4tDeCheck1tDeCheck2$$If!vh5<'#v<':V l46 t 6Pi0<'6,5<'/ f4vDText18vDText19vDText20$$If!vh5<'#v<':V l4X t 6Pi0<'6,5<'/ f4vDText21vDText228@8 Normal_HmH sH tH N@N Heading 1$$@&`a$ 5CJ,aJ4DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List PC@P Body Text Indent ^ CJ\aJ6U@6 Hyperlink >*B*ph:B@: Body Text CJ\aJ4@"4 Header  !4 @24 Footer  ! 0JK56lHX ,LMh^_ )h   ~ 0000000 0 0 0 0 000 00 0 00 00 00 0 000000 00000 0 0 0 0 0 00000000I00rI00I00rI00I00rI00I00rI00@0I00I00P /////2$*8DJT`fo{,<IYw ( . 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