DSC04020

DSC03653

DSC03989

DSC04020

1/5

APPLICATION

We're so excited that you are considering becoming a Master Clinician! In order to apply, please carefully read over the requirements and optional certifications. If you have met all of the required tasks,

JUMP DOWN TO FILL OUT THE APPLICATION!

*Please note that unfortunately, the application does not save on the browser so that you can come back to finish it later. It must all be filled out at once. We encourage you to make sure you have all of the materials collected before starting your application!

MASTER CLINICIAN REQUIREMENTS:

REQUIREMENT 1: CONTINUING EDUCATION

Total of 32 completed hours of CEUs related to the topic area is required.

REQUIREMENT 3: CASE REPORT

Complete and submit a case report.
You can utilize "How to Write a Case Report” and “Steps on Writing a Case Report”

REQUIREMENT 2: ARTICLE APPRAISALS

Total of 10 article appraisals are required.
Relevant articles on topic are to get chosen for appraisal.
You can utilize the template included as a guide for the article appraisal: CLICK HERE FOR THE TEMPLATE.

REQUIREMENT 4: PORTFOLIO

Final submission should be in the form of a portfolio that the candidate submits for review in its entirety.
Electronic version (PDF Format in a zip file/folder) that includes all required documents in organized fashion.
- Name, Master Clinician Designation, Facility, Email.
- Master Clinician Completion Form.
- Folder 1: CEU Certificates (Saved as one PDF).
- Folder 2: Article Appraisals (Saved as one PDF); The application process does not support multiple articles to get uploaded as separate files; Will make it uniform to assist getting the appraisals uploaded as one PDF.
- Folder 3: Case Report (Saved as a PDF).

OPTIONAL CERTIFICATION:

Therapists who already have specialist certifications through their professional organization will get granted Master Clinician status after they have completed and submitted a case report. Please contact the Master Clinician Committee.
The following Board Certifications through professional organizations will be accepted:
- APTA: Geriatrics, Cardio-Pulmonary, Neurology, Orthopedics, CEEAA.
  - https://specialization.apta.org/
- AOTA: Gerontology.
  - https://www.aota.org/career/advanced-certification-program
- ASHA: Swallowing (BCS-S)
  - https://www.asha.org/certification/clinical-specialty-certification/
If a certification is not listed and you feel it meets the level of education comparable to above listed certifications, please contact the Master Clinician Committee and your certification will get evaluated.

MASTER CLINICIAN APPLICATION

Name*

First Name

Last Name

Email & Phone*

Employee Email

Phone Number

Employee ID, Affiliated Facility Name, Discipline, City, State & DOR, ED, Therapy Resource Contact Information

Employee ID Number

Employee Affiliated Facility City & State

Employee Affiliated Facility Name

DOR's Name

DOR's Email

ED's Name

ED's Email

Therapy Resource's Name

Therapy Resource's Email

Program Not Listed In Drop-Down? Write It Here!

Short Answers & File Attachments*

1. List Continuing Education Courses associated with your area of expertise (at least 32 hours of CEUs). List each Course Title, Date, Location and number of CEUs.

Upload Combned .PDF File of All Certifications

2. Attach your 10 Article Appraisals associated with your area of expertise. Use the template as a guide for the article appraisals. (note: you will need to combine the Article Appraisals into one file.)

Upload Combined .PDF File of 10 Artical Appraisals

3. Attach your Case Report. Utilize the "How to Write a Case Report" and "Steps on Writing a Case Report". (View Case Study Example 1. View Case Study Example 2, Obtain Patient Authorization Form).

Upload Case Report

Upload Signed Authorization Form

Patient’s Medical Record Number (MRN)

Start of Care (SOC) of Patient's case

Please provide the patient’s Medical Record Number (MRN) and Start of Care (SOC) from NetHealth associated with the Case Report, so the patient’s NH documentation can be reviewed. The MRN is located at the top of the patient’s Case Manager as shown in the screenshot to the right.

4. Portfolio. Describe your strengths, weaknesses, knowledge, experience, etc. associated with your area of expertise. Why are you passionate about this area and should be considered a Master Clinician? Please provide any additional information that should be considered.

Master Clinician Applicaton