Dysphagia Competency Verification Tool Users Guide€¦ · Dysphagia assessment and management now...

Dysphagia Competency Verification Tool (DCVT)

User’s Guide

This tool is consensus-based and provided as a resource for members of the American Speech Language-Hearing Association (ASHA). Information included in this tool does not represent official ASHA policy. Portions of this tool are reprinted with permission from the American Board of Swallowing and Swallowing Disorders (ABSSD).

Contents• Introduction• Prerequisites for Utilizing the DCVT • Role of Preceptor• Competency Sections

Clinical Swallow Assessment and Dysphagia Treatment Videofluoroscopic Swallow Study (VFSS) Competency Fiberoptic Endoscopic Evaluation of Swallow with and without Sensory Testing (FEES/

ST) Competency High-Resolution Manometry (HRM) Competency Continued Competency Review Specialization and Professional Development

• Age-Specific Competencies• Special Populations and Facility-Specific Competencies• Rating Levels of the DCVT• Implementation of the DCVT• Works Consulted

Introduction Clinicians can use the Dysphagia Competency Verification Tool (DCVT) to systematically assess clinical competence for the provision of dysphagia services. This tool was developed by the Special Interest Group on Swallowing and Swallowing Disorders (Dysphagia) (SIG13) and by the American Board of Swallowing and Swallowing Disorders (AB-SSD) Joint Committee on Dysphagia Competencies in response to affiliates’ request for guidance and guidelines for establishing and measuring clinical competence in the areas of (a) feeding and swallowing and (b) swallowing disorders. This tool is intended to be a resource for clinicians to use for self-assessment and for employers, supervisors, or preceptors to use as a tool for evaluating and documenting dysphagia knowledge and skill competencies.


Dysphagia assessment and management now represents 39% of the caseload of responding speech-language pathologists (SLPs) in health care settings who treat adults and 16% of the caseload of responding pediatric SLPs, according to the ASHA 2017 Health Care Survey. ASHA anticipates that the demand for dysphagia services will continue to grow as advances in medical care extend life at both ends of the age spectrum. Many settings require documented competencies for privileging of services provided or procedures performed. The Joint Commission (n.d.) states the following:

The competency assessment looks at whether the clinical staff has the skills, knowledge, and abilities to perform the assigned job duties. Competency must be assessed by staff who understands the skills and knowledge required by the job responsibilities. Beyond the documented initial assessment to be finalized upon the completion of the staff’s orientation, competency should be assessed on an on-going basis with documentation of such at least once every two years. (The Joint Commission, n.d., para 1)

This document is a guide to assist the user in maximizing the utility of the DCVT. It describes the sections of the DCVT and the prerequisites for clinical advancement. The tool and guide will be available on the ASHA website and are openly sourced for clinical and facility use.The DCVT is intended to be a fluid document and will be reviewed and updated annually as evidence-based practice continues to evolve.

Prerequisites for Utilizing the DCVTClinicians can utilize the DCVT provided that they meet the following prerequisites:

• Graduation from an accredited speech-language pathology program • Knowledge of typical anatomy and physiology, including neuroanatomy and physiology, pertaining to the

swallowing mechanism and related systems across the age continuum• Knowledge of relevant risk factors and clinical indicators of dysphagia across the age continuum

Individual facilities may choose to assess and/or document knowledge via written test, discussion with preceptor, and/or application of knowledge in supervised practice.

Role of PreceptorThe preceptor is a practicing clinician with the desired skills and knowledge designated to give personal instruction, training, and supervision to the clinician-in-training. When possible, the preceptor should be available on site to directly observe the skills being assessed. When a preceptor is unavailable, this tool can be utilized as a self-assessment tool to highlight areas in need of development. Clinicians can then seek support from their local and ASHA community for professional growth.


Competency SectionsClinical Swallow Assessment and Dysphagia Treatment — This section describes the core competencies of the clinician evaluating and treating a patient with dysphagia. These are the clinical skills necessary to assess swallowing function in a clinical setting and to provide the appropriate intervention based on the patient’s/client’s age and disorder. The clinician can indicate specific age groups of interest based on the setting and job requirements. The clinician can modify the tool to reflect special population needs (i.e., clients with developmental disabilities, patients with head and neck cancer) or setting-specific needs (i.e., school, skilled nursing facility). Prerequisites for this competency are the previously referenced knowledge documents. Additional sections are specific to instrumental examinations. In order to acquire the necessary skills, clinicians may benefit from topic-specific continuing education, observation, and mentored learning as prerequisites to clinical competency in the performance of procedures.

Videofluoroscopic Swallow Study (VFSS) Competency — This section describes the clinical skills necessary to perform and interpret the VFSS. The clinician can indicate specific age groups of interest based on the setting and job requirements. The clinician can modify the tool to reflect special population needs and setting-specific skills. Prerequisites for this competency are the skills and knowledge documented in the Dysphagia Clinical Competency section of this document as well as the previously referenced knowledge documents.

Fiberoptic Endoscopic Evaluation of Swallowing with and without Sensory Testing (FEES/ST) Competency — This section describes the clinical skills necessary to perform and interpret the FEES/ST. The clinician can indicate specific age groups of interest based on the setting and job requirements. The clinician can modify the tool to reflect special population needs and setting-specific skills. Prerequisites for this competency are the skills and knowledge documented in the Dysphagia Clinical Competency section of this document as well as the previously referenced knowledge documents.

High-Resolution Manometry (HRM) Competency — This section describes the clinical skills necessary to perform and interpret the HRM. The clinician can indicate specific age groups of interest based on the setting and job requirements. The tool can be modified to reflect special population needs and setting-specific skills. Prerequisites for this competency are the skills and knowledge documented in two previous sections of this document (the Dysphagia Clinical Competency section and the FEES/ST Competency section) as well as the previously referenced knowledge documents.

Continued Competency Review — This section is an annual or biennial review of previously documented skills and privileges. The supervisor reviews three main knowledge areas—(a) the frequency of skill utilization (i.e., number of procedures that the clinician performed or treatment sessions that the clinician provided); (b) the number of accuracy and safety concerns that the clinician documented; and/or (c) the clinician’s ability to successfully function as a preceptor. These three areas then provide the basis for recommendations regarding clinical advancement or modification.

Specialization and Professional Development — This section contains a list of knowledge, skills, and experiences that reflect advanced competencies and professional development. The clinician can use documentation of education and mentorship, leadership roles, and research or scholarly activities in the area of feeding and swallowing development and disorders as a clinical ladder within a facility (e.g., advancement to preceptor) or as a method of tracking professional activities for board specialization. This list is not all inclusive, nor are all items required to reflect specialization. The content in this section is reprinted with permission from the American Board of Swallowing and Swallowing Disorders.


Age-Specific Competencies Age-specific competencies are skills specific to defined age groups. Clinicians must know the principles of growth and development over the life span, must be able to assess clinical data relative to patient age, and must be able to interpret the information needed to identify patient needs relative to age-specific needs.

Special Populations and Facility-Specific Competencies Details about special populations and facility-specific competencies can be added to the tool to meet additional and/or unique needs of individual facilities beyond the core competencies of the DCVT.

Rating Levels of the DCVTThere are three main rating levels within the DCVT. These levels are defined below.

1. In Training — Identifies that the clinician’s knowledge or skill is still in development and that continued supervision by a preceptor is required.

2. Competent — Identifies that the clinician (a) has mastered the required basic knowledge and skills and (b) no longer requires supervision by the preceptor. Clinicians can continue to grow and develop beyond the rating level of “competent” through pursuit of advanced training.

3. Self-assessment — Assessing one’s own knowledge and skills encourages the clinician-in-training to reflect on strengths and areas of growth in order to foster discussion and direct continued learning.

Implementation of the DCVTClinicians-in-training can follow these eight steps in order to implement the DCVT in their clinical setting:

1. Modify the DCVT to meet specific needs of the facility and population to be served.2. Identify age groups to be managed within job specifications.3. Identify a preceptor with documented knowledge and skills.4. Perform a self-assessment to determine one’s self-perception of current skills and knowledge base.5. Identify areas of opportunity for skill development and provide additional training/resources as indicated.6. Perform procedure(s) with supervision from preceptor until the clinician-in-training demonstrates the

expected standard of care and skills needed to independently perform the procedure(s) with each age group requested.

7. Perform annual competency review.8. Utilize specialization for clinical advancement.


Works Consulted

American Board of Swallowing and Swallowing Disorders. (n.d.) Application for Board Certification. Retrieved from https://cdn.ymaws.com/www.swallowingdisorders.org/resource/resmgr/application/appendix_a-d.pdf

ACR: American College of Radiology. (n.d.). Clinical resources—Radiology safety. Retrieved from https://www.acr.org/Quality-Safety/Radiology-Safety

American Speech-Language-Hearing Association. (n.d.-a). Adult Dysphagia (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/

American Speech-Language-Hearing Association. (n.d.-b). ASHA 2017 Health Care Survey. Retrieved from https://www.asha.org/Research/memberdata/HealthcareSurvey/

American Speech-Language-Hearing Association. (n.d.-c). Cleft Lip and Palate (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Cleft-Lip-and-Palate/

American Speech-Language-Hearing Association. (n.d.-d). Dementia (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Dementia/

American Speech-Language-Hearing Association. (n.d.-e). End-of-life issues in speech-language pathology. Retrieved from https://www.asha.org/slp/clinical/endoflife/

American Speech-Language-Hearing Association. (n.d.-f). Head and Neck Cancer (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Head-and-Neck-Cancer/

American Speech-Language-Hearing Association. (n.d.-g). Pediatric Dysphagia (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/

American Speech-Language-Hearing Association. (n.d.-h). Pediatric Traumatic Brain Injury (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Traumatic-Brain-Injury/

American Speech-Language-Hearing Association. (n.d.-i). Pediatric Traumatic Brain Injury—Assessment (Practice Portal). Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942939&section=Assessment

American Speech-Language-Hearing Association. (n.d.-j). Tracheostomy and ventilator dependence. Retrieved from https://www.asha.org/slp/clinical/Tracheostomy/

American Speech-Language-Hearing Association. (n.d.-k). Traumatic Brain Injury in Adults (Practice Portal). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Traumatic-Brain-Injury-in-Adults/

CARF International—Commission on Accreditation of Rehabilitation Facilities. (2018). Accreditation—Quality standards. Retrieved from http://www.carf.org/Accreditation/QualityStandards/

The Joint Commission. (n.d.). Are competency assessments and performance evaluations the same or two different requirements? Retrieved from https://www.jointcommission.org/standards_information


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Privilege: Clinical Swallow Assessment and Dysphagia TreatmentCPT: 92610, 92526

Applicant name:______________________________________________________________________________

Date training initiated: _____________________ Date competency attained: _____________________________

Preceptor name(s): ____________________________________________________________________________

Age group: Premature infants (


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General Skills SARatingPARating Date

Collaborates with relevant team members regarding patient careDescribes and integrates evidence-based practice into patient assessment and careRecognizes medical contraindications of proceeding with direct assessment, signs of patient distress, and necessary responseDescribes differences between screening and assessmentDescribes indications and contraindications for instrumental swallow study referral

Direct Patient Care SARatingPARating Date

Obtains comprehensive medical and dysphagia history, including nature and duration of signs and symptoms, prior dysphagia evaluation or treatment, response to treatment, and cultural and/or linguistic factors that may influence the patient’s preferences and attitudes toward feeding and/or swallowingDetermines baseline and current nutritional intake (e.g., positioning, feeding dependency, environment, diet modification, com-pensations)Identifies when swallowing assessment and intervention is appropriateConducts an oral, pharyngeal, laryngeal, cranial nerve, and respiratory function examination as it relates to functional assess-ment of feeding and/or swallowingIdentifies abnormal/atypical structure and functionAssembles the appropriate assessment materials (e.g., nipples, bottles, utensils, cups, foods/liquids) as per facility-specific protocolIdentifies significant signs, symptoms, medical conditions, and medications pertinent to dysphagia during clinical assessmentRecognizes clinical signs and symptoms of airway compromiseTests interventions, including but not limited to postural changes, behavioral changes, maneuvers,bolus modifications (e.g., texture, volume), delivery method (e.g., spoon, cup, bottle, nipple type), and sensory enhancement techniques to improve safety and efficiency of the swallow and trials, as appropriateRefers for appropriate diagnostic tests, including instrumental swallow assessment, and consultations when indicatedProvides recommendations regarding delivery of nutrition and hydration (oral, non-oral, or combination of the two)


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Direct Patient Care SARatingPARating Date

Provides recommendations regarding specific oral intake modifications (e.g., volume, viscosity, texture, etc.)Provides recommendations regarding compensatory and feeding precautions (e.g., strategies, positioning, assistance, supervi-sion, etc.)Provides recommendations regarding rehabilitation treatment targeting physiologic deficits identified on assessment, utilizing evidence-based techniques when availableIntegrates and adapts plan of care to include patient’s cultural and personal preferencesProvides a prognostic statementEducates the patient and family/caregiver to the findings and recommendations, including options and relative risks/benefitsEducates the staff (e.g., physicians, nurses/CNAs, care planning team, teachers, aides) as to findings and recommendations, and advocates for swallowing-related servicesGenerates documentation that is clear, concise, complete, and interpretive (e.g., assessment performed/findings, impression, severity, prognosis, recommendations, and goals)Identifies necessary follow-up care, including frequency of treatment, monitoring, and/or reevaluationProvides ongoing assessment and revises treatment goals as appropriate, based on patient responseDevelops and implements treatment plan targeting physiologic deficits identified on assessmentDocuments response to treatment using objective and measurable data collection systemsAdjusts treatment plan, content and delivery to the level of the person being educated, counseled, or trainedIdentifies discharge/dismissal criteriaSeeks assistance and collaboration as needed in the assessment and care of persons with dysphagia

Population- and Setting-Specific Skills (e.g., Trach/Vent, HNC, NICU, etc.)Describes best practices for providing interventions when complicated and/or special medical conditions are seen which may have an impact on an individual’s feeding and swallowing (population/setting specific skills may beadded below)

Clinician Name/Initials: ________________________________________________________________________

Primary Preceptor/Initials: ______________________________________________________________________

Date Privileging Process Initiated: _________________________________________________________________


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Privilege: Videofluoroscopic Swallow Study (VFSS)CPT: 92611

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Date training initiated: ______________________________________ Date competency attained:______________

Preceptor name(s): ____________________________________________________________________________

Prerequisites: Privileges in Clinical Swallow Assessment and Dysphagia Treatment



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Procedure-Related Skills SA Rating PA Rating DateEvaluates the individual’s tolerance of and ability to perform and repeat appropriate therapeutic interventions as appropriate, based on radiographic findings and the individual’s overall functioning levelConducts the examination in a timely manner to minimize radiation exposureMonitors possible adverse reactions to the examination (e.g., changes in breathing pattern, level of alertness, agitation, pallor, etc.)Reviews the recorded VFSSIdentifies and documents the physiologic components of swallowingIdentifies and documents the impact of anatomic and physiologic impairment (i.e., location and severity of residue, laryngeal pen-etration, presence, timing, and approximate percentage of aspiration)Documents the patient’s apparent awareness of and response to residue, laryngeal penetration, and/or aspiration (i.e., cough, throat clear, second swallow)Documents compensatory postures, maneuvers, delivery methods, sensory enhancements, and bolus modifications attempted—and the effectiveness of eachDocuments the individual’s tolerance of and response to study (e.g., ability to follow directions, fatigue factor, and ability to repeat therapeutic interventions)If esophageal screening is completed, describes any suspected anatomic and/or physiologic abnormalities of the esophagus which might impact the pharyngeal swallow, deferring to radiology for diagnostic statementsFormulates treatment and management strategies based on patient performance and integrates patient, family, and caregiver input into treatment planInterprets and documents findings in a written report, including diagnosis, severity, prognosis, recommendations, and goalsDiscusses the results and consults with appropriate medical personnel in a collaborative model, as possibleRefers for additional instrumental swallowing examinations (e.g., FEES, HRM), as appropriate, based on findingsIncorporates radiation safety techniques (e.g., time, distance, shielding) for all individuals within the radiology suite during the examinationInforms appropriate personnel (e.g., radiation safety officer) of any special circumstances that might impact the clinician’s ability to participate in the videofluoroscopic swallowing exam and take appropriate action to ensure personal safety

Population- and Setting-Specific Skills (e.g., Trach/Vent, HNC, NICU, etc.)Describes best practices for providing interventions when complicated and/or special medical conditions are seen which may have an impact on an individual’s feeding and swallowing (population/setting specific skills may be added below)





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Privilege: Fiberoptic Endoscopic Evaluation of Swallowing (FEES)CPT: 92612

Applicant name:______________________________________________________________________________


Preceptor name(s): ____________________________________________________________________________

Key: SA=Self-Assessment PA =Preceptor Assessment T = Training C =Competent

Instructions: Applicant will perform procedure with supervision from preceptor until the applicant demonstrates the expected standard of care and skills needed to independently perform the procedure with each age group requested.

SA:Baseline rating

PA: Date competen-cy demon-strated

Procedure-Related Skills SARatingPARating Date

Recognizes anatomical landmarks as viewed endoscopicallyIdentifies the indications and contraindications for FEES, including who is and is not a candidate for the studyIdentifies and explains the risks, benefits, and precautions related to FEESIdentifies the elements of a comprehensive FEESAdapts evaluation, as appropriate, for patient’s medical diagnosis or response (e.g., BOLT, esophago, cardiac, etc.)Operates, maintains, and disinfects the equipment needed for an endoscopic examinationApplies topical anesthetic when clinically appropriate and when permitted by the licensing regulations of individual statesInserts and manipulates the endoscope that obtains desired view in a manner that causes minimal discomfort and prevents unpleasant complicationsManipulates the endoscope within the hypopharynx to obtain the desired viewDirects the patient through appropriate tasks and maneuvers as required for a complete and comprehensive examination


Demonstrates knowledge of medical contraindications, impending signs of patient distress, and appropriate actions to take if complications ariseDetects and interprets abnormal findings in terms of the underlying anatomy and pathophysiologyAssesses vocal fold mobility and laryngeal closure for phonation, breath holding, and coughAssesses secretion management, quantity and location of pharyngeal residue, pharyngeal constriction/contraction symmetry, and swallow initiationPresents various bolus consistencies, dyed green for contrast, based on clinical assessment

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Please see https://www.asha.org/practice/reimbursement/coding/SLPCPT/ for updated coding guidance.

https://www.asha.org/practice/reimbursement/coding/SLPCPT/


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Determines presence, amount, and timing of any laryngeal penetration and/or aspiration, noting if silent vs. audible and protective vs. unprotectiveApplies appropriate treatment interventions, implements postural changes, and alters the bolus or method of delivery to deter-mine the effect on the swallowUses the results of the examination to make appropriate recommendations and to guide treatment of the patientUses endoscopy as a biofeedback tool and educates patients, family, and staff using the endoscopic images either during or after the examinationInterprets and documents findings in a written report, including diagnosis, severity, prognosis, recommendations, and goalsFormulates treatment and management strategies based on patient performance and integrates patient, family, and caregiver input into treatment planMakes appropriate referrals based on findings


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Privilege: High-Resolution Manometry (HRM)CPT: 92700

Applicant name:______________________________________________________________________________


Preceptor name(s): ____________________________________________________________________________

Prerequisites: Privileges in Clinical Swallow Assessment and Dysphagia Treatment; Fiberoptic Endoscopic Evaluation of Swallowing (FEES)



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Determines if evaluation of swallow physiology is represented by spatiotemporal plots and manually derived pressure and impedance measuresAssesses postures and maneuvers based on imaging and manometric findingsMonitors for possible risks related to examinationRemoves manometer catheter in a manner that prevents complications and causes minimal discomfortInterprets and documents findings in a written reportIntegrates findings into dysphagia diagnosis and treatment planUtilizes examination to provide biofeedback during dysphagia therapy






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Continued Competency Review

Date:__________________

Clinician Name: ______________________________________________________________________________

Reviewer Name: ______________________________________________________________________________

Date Range: _________________________________________________________________________________

A review of the clinician’s performance has been conducted and reveals the following:

CompetencyNumber Completed

Number of accuracy concerns

Number of safety concerns

Successful function as a preceptor?

Clinical Swallow EvaluationDysphagia TreatmentVFSSFEESHRM

Recommendations: Continue current competencies Continue current competencies as defined with implementation of a performance improvement plan: Modify/change current competencies

Discontinue competencies for the following procedure(s):

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Specialization and Professional DevelopmentExamples of Advanced Knowledge, Skills, and Experiences Taken From Appendix C of ABSSD application

Education/MentorshipContent/Objective Type/Location CompletionDatePresent paper or poster at a state or national association meetingServe as supervisor for clinicians/studentsInitiate/maintain journal groupDevelop and provide education to professionals within facility/region about swallowing/swallowing disordersProvide education to community-based groups regarding swallowing and swallowing disordersProvide guest lectures in university coursesServe as professor or instructor for undergraduate or graduate course on swallowing and swallowing disor-ders in ASHA CAA–accredited university programDevelop course syllabus for undergraduate/graduate course on swallowing and swallowing disordersProvide educational presentations at major regional, state, national, or international conferences and/or postgraduate workshops on swallowing and/or swallowing disordersDevelop facility-specific patient and staff educational materials on swallowing and swallowing disordersDevelop/publish clinical educational programs and/or materials on swallowing and swallowing disordersServe as primary advisor to a master’s degree or doctoral student to guide research for thesis or dissertation

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LeadershipContent/Objective Type/Location CompletionDateServe on interdisciplinary team or committee related to dysphagiaServe as chair of committee within home institution or organizationServe in a leadership position on an ASHA committee or other professional organization pertaining to swallowing and swallowing disordersServe as participant during the development of ASHA or state association position papers or guidelines on swallowing and swallowing disordersServe on major regional, state, or national organization committees pertaining to swallowing and swallowing disordersServe in official supervisory position in a swallowing and swallowing disorders program, with responsibilities that include training and supervision of clinicians providing dysphagia servicesDevelop formal swallowing program within an institution, with involvement of multiple disciplinesDemonstrate accountability in ongoing monitoring and quality improvement of swallowing and swallowing disorders programDemonstrate ability to expand dysphagia program aspects, addition of new programs, services

Scholarship/ResearchContent/Objective Type/Location CompletionDateSubmit and publish peer-reviewed research article as primary or secondary authorSubmit and publish a chapter related to swallowing and swallowing disorders in a peer-reviewed textbookPresent a peer-reviewed research paper or poster at a scientific meetingActively participate in research pertaining to swallowing and swallowing disorders with institutional re-search board approval, including research projects and protocols, surveys





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Applicant Name: Preceptor: DAte training initiated: Premature infants: Neonate: Infant: Toddler: Child: Adolescent: Adult: Geriatric: SA:Baseline rating: SA:Baseline rating 2: SA:Baseline rating 3: SA:Baseline rating 4: SA:Baseline rating 5: SA:Baseline rating 6: SA:Baseline rating 7: SA:Baseline rating 8: SA:Baseline rating 9: PA: Date competency demonstrated: PA: Date competency demonstrated 2: PA: Date competency demonstrated 3: PA: Date competency demonstrated 4: PA: Date competency demonstrated 5: PA: Date competency demonstrated 6: PA: Date competency demonstrated 7: PA: Date competency demonstrated 8: PA: Date competency demonstrated 9: Date: Date 2: Date 3: Date 4: Date 5: Date 6: Date 7: Date 8: Date 9: Date competency attained: SA:Baseline rating 10: SA:Baseline rating 11: SA:Baseline rating 12: SA:Baseline rating 13: SA:Baseline rating 14: SA:Baseline rating 15: SA:Baseline rating 16: SA:Baseline rating 17: SA:Baseline rating 18: SA:Baseline rating 19: SA:Baseline rating 20: SA:Baseline rating 21: SA:Baseline rating 22: SA:Baseline rating 23: SA:Baseline rating 24: SA:Baseline rating 25: PA: Date competency demonstrated 10: PA: Date competency demonstrated 11: PA: Date competency demonstrated 12: PA: Date competency demonstrated 13: PA: Date competency demonstrated 14: PA: Date competency demonstrated 15: PA: Date competency demonstrated 16: PA: Date competency demonstrated 17: PA: Date competency demonstrated 18: PA: Date competency demonstrated 19: PA: Date competency demonstrated 20: PA: Date competency demonstrated 21: PA: Date competency demonstrated 22: PA: Date competency demonstrated 23: PA: Date competency demonstrated 24: PA: Date competency demonstrated 25: Date 10: Date 11: Date 12: Date 13: Date 14: Date 15: Date 16: Date 17: Date 18: Date 19: Date 20: Date 21: Date 22: Date 23: Date 24: Date 25: SA:Baseline rating 26: SA:Baseline rating 27: SA:Baseline rating 28: SA:Baseline rating 29: SA:Baseline rating 30: SA:Baseline rating 31: SA:Baseline rating 32: SA:Baseline rating 33: SA:Baseline rating 34: SA:Baseline rating 35: SA:Baseline rating 36: SA:Baseline rating 37: SA:Baseline rating 38: SA:Baseline rating 39: SA:Baseline rating 40: SA:Baseline rating 41: Clincian Name: Date Privileging Process: PA: Date competency demonstrated 26: PA: Date competency demonstrated 27: PA: Date competency demonstrated 28: PA: Date competency demonstrated 29: PA: Date competency demonstrated 30: PA: Date competency demonstrated 31: PA: Date competency demonstrated 32: PA: Date competency demonstrated 33: PA: Date competency demonstrated 34: PA: Date competency demonstrated 35: PA: Date competency demonstrated 36: PA: Date competency demonstrated 37: PA: Date competency demonstrated 38: PA: Date competency demonstrated 39: PA: Date competency demonstrated 40: PA: Date competency demonstrated 41: Date 26: Date 27: Date 28: Date 29: Date 30: Date 31: Date 32: Date 33: Date 34: Date 35: Date 36: Date 37: Date 38: Date 39: Date 40: Date 41: Notes 1: Applicant Name 2: Preceptor 2: DAte training initiated 2: Premature infants 2: Neonate 2: Infant 2: Toddler 2: Child 2: Adolescent 2: Adult 2: Geriatric 2: Date competency attained 2: SA:Baseline rating 42: SA:Baseline rating 43: SA:Baseline rating 44: SA:Baseline rating 45: SA:Baseline rating 46: SA:Baseline rating 47: SA:Baseline rating 48: SA:Baseline rating 49: SA:Baseline rating 50: PA: Date competency demonstrated 42: PA: Date competency demonstrated 43: PA: Date competency demonstrated 44: PA: Date competency demonstrated 45: PA: Date competency demonstrated 46: PA: Date competency demonstrated 47: PA: Date competency demonstrated 48: PA: Date competency demonstrated 49: PA: Date competency demonstrated 50: Date 42: Date 43: Date 44: Date 45: Date 46: Date 47: Date 48: Date 49: Date 50: SA:Baseline rating 51: SA:Baseline rating 52: SA:Baseline rating 53: SA:Baseline rating 54: PA: Date competency demonstrated 51: PA: Date competency demonstrated 52: PA: Date competency demonstrated 53: PA: Date competency demonstrated 54: Date 51: Date 52: Date 53: Date 54: SA:Baseline rating 55: SA:Baseline rating 56: SA:Baseline rating 57: SA:Baseline rating 58: SA:Baseline rating 59: SA:Baseline rating 60: SA:Baseline rating 61: SA:Baseline rating 62: SA:Baseline rating 63: SA:Baseline rating 64: SA:Baseline rating 65: SA:Baseline rating 66: SA:Baseline rating 67: SA:Baseline rating 68: SA:Baseline rating 69: SA:Baseline rating 70: SA:Baseline rating 71: PA: Date competency demonstrated 55: PA: Date competency demonstrated 56: PA: Date competency demonstrated 57: PA: Date competency demonstrated 58: PA: Date competency demonstrated 59: PA: Date competency demonstrated 60: PA: Date competency demonstrated 61: PA: Date competency demonstrated 62: PA: Date competency demonstrated 63: PA: Date competency demonstrated 64: PA: Date competency demonstrated 65: PA: Date competency demonstrated 66: PA: Date competency demonstrated 67: PA: Date competency demonstrated 68: PA: Date competency demonstrated 69: PA: Date competency demonstrated 70: PA: Date competency demonstrated 71: Date 55: Date 56: Date 57: Date 58: Date 59: Date 60: Date 61: Date 62: Date 63: Date 64: Date 65: Date 66: Date 67: Date 68: Date 69: Date 70: Date 71: Clinician Name: Date Privileginh Process: Primary Preceptor: Notes 3: Applicant Name 3: Preceptor 3: DAte training initiated 3: SA:Baseline rating 72: SA:Baseline rating 73: SA:Baseline rating 80: SA:Baseline rating 74: SA:Baseline rating 75: SA:Baseline rating 76: SA:Baseline rating 77: SA:Baseline rating 78: PA: Date competency demonstrated 72: PA: Date competency demonstrated 73: PA: Date competency demonstrated 80: PA: Date competency demonstrated 74: PA: Date competency demonstrated 75: PA: Date competency demonstrated 76: PA: Date competency demonstrated 77: PA: Date competency demonstrated 78: Date 72: Date 73: Date 80: Date 74: Date 75: Date 76: Date 77: Date 78: SA:Baseline rating 79: PA: Date competency demonstrated 79: Date 79: SA:Baseline rating 81: PA: Date competency demonstrated 81: Date 81: Date competency attained 3: SA:Baseline rating 82: SA:Baseline rating 83: SA:Baseline rating 84: SA:Baseline rating 85: SA:Baseline rating 86: PA: Date competency demonstrated 82: PA: Date competency demonstrated 83: PA: Date competency demonstrated 84: PA: Date competency demonstrated 85: PA: Date competency demonstrated 86: Date 82: Date 83: Date 84: Date 85: Date 86: SA:Baseline rating 87: SA:Baseline rating 88: SA:Baseline rating 89: SA:Baseline rating 90: SA:Baseline rating 91: SA:Baseline rating 92: SA:Baseline rating 93: PA: Date competency demonstrated 87: PA: Date competency demonstrated 88: PA: Date competency demonstrated 89: PA: Date competency demonstrated 90: PA: Date competency demonstrated 91: PA: Date competency demonstrated 92: PA: Date competency demonstrated 93: Date 87: Date 88: Date 89: Date 90: Date 91: Date 92: Date 93: SA:Baseline rating 94: PA: Date competency demonstrated 94: Date 94: Notes 6: Notes 2: Applicant Name 4: Preceptor 4: DAte training initiated 4: Premature infants 3: Neonate 3: Infant 3: Toddler 3: Child 3: Adolescent 3: Adult 3: Geriatric 3: Date competency attained 4: SA:Baseline rating 95: SA:Baseline rating 96: SA:Baseline rating 97: SA:Baseline rating 98: SA:Baseline rating 99: SA:Baseline rating 100: SA:Baseline rating 101: SA:Baseline rating 102: SA:Baseline rating 103: PA: Date competency demonstrated 95: PA: Date competency demonstrated 96: PA: Date competency demonstrated 97: PA: Date competency demonstrated 98: PA: Date competency demonstrated 99: PA: Date competency demonstrated 100: PA: Date competency demonstrated 101: PA: Date competency demonstrated 102: PA: Date competency demonstrated 103: Date 95: Date 96: Date 97: Date 98: Date 99: Date 100: Date 101: Date 102: Date 103: SA:Baseline rating 104: SA:Baseline rating 105: SA:Baseline rating 106: SA:Baseline rating 107: SA:Baseline rating 108: PA: Date competency demonstrated 104: PA: Date competency demonstrated 105: PA: Date competency demonstrated 106: PA: Date competency demonstrated 107: PA: Date competency demonstrated 108: Date 104: Date 105: Date 106: Date 107: Date 108: SA:Baseline rating 109: SA:Baseline rating 110: SA:Baseline rating 111: SA:Baseline rating 112: SA:Baseline rating 113: SA:Baseline rating 114: SA:Baseline rating 115: PA: Date competency demonstrated 109: PA: Date competency demonstrated 110: PA: Date competency demonstrated 111: PA: Date competency demonstrated 112: PA: Date competency demonstrated 113: PA: Date competency demonstrated 114: PA: Date competency demonstrated 115: Date 109: Date 110: Date 111: Date 112: Date 113: Date 114: Date 115: SA:Baseline rating 116: PA: Date competency demonstrated 116: Date 116: Clinician Name 2: Date Privileginh Process 2: Primary Preceptor 2: Applicant Name 5: Preceptor 5: Preceptor 6: DAte training initiated 5: SA:Baseline rating 117: SA:Baseline rating 118: SA:Baseline rating 119: SA:Baseline rating 120: SA:Baseline rating 121: SA:Baseline rating 122: SA:Baseline rating 123: SA:Baseline rating 124: SA:Baseline rating 125: PA: Date competency demonstrated 117: PA: Date competency demonstrated 119: PA: Date competency demonstrated 121: PA: Date competency demonstrated 123: PA: Date competency demonstrated 125: PA: Date competency demonstrated 118: PA: Date competency demonstrated 120: PA: Date competency demonstrated 122: PA: Date competency demonstrated 124: PA: Date competency demonstrated 126: Date 117: Date 118: Date 119: Date 120: Date 121: Notes 4: SA:Baseline rating 126: SA:Baseline rating 128: SA:Baseline rating 130: SA:Baseline rating 132: SA:Baseline rating 134: SA:Baseline rating 136: SA:Baseline rating 138: SA:Baseline rating 140: SA:Baseline rating 142: SA:Baseline rating 144: SA:Baseline rating 146: SA:Baseline rating 148: SA:Baseline rating 127: SA:Baseline rating 129: SA:Baseline rating 131: SA:Baseline rating 133: SA:Baseline rating 135: SA:Baseline rating 137: SA:Baseline rating 139: SA:Baseline rating 141: SA:Baseline rating 143: SA:Baseline rating 145: SA:Baseline rating 147: SA:Baseline rating 149: SA:Baseline rating 150: SA:Baseline rating 151: SA:Baseline rating 152: SA:Baseline rating 153: SA:Baseline rating 154: SA:Baseline rating 155: SA:Baseline rating 156: SA:Baseline rating 157: SA:Baseline rating 176: SA:Baseline rating 174: SA:Baseline rating 158: SA:Baseline rating 159: SA:Baseline rating 160: SA:Baseline rating 161: SA:Baseline rating 162: SA:Baseline rating 163: SA:Baseline rating 164: SA:Baseline rating 165: SA:Baseline rating 166: SA:Baseline rating 167: SA:Baseline rating 168: SA:Baseline rating 169: SA:Baseline rating 177: SA:Baseline rating 175: SA:Baseline rating 170: SA:Baseline rating 171: SA:Baseline rating 172: SA:Baseline rating 173: Clinician Name 3: Date Privileginh Process 3: Primary Preceptor 3: Notes 5:

Dysphagia Competency Verification Tool Users Guide€¦ · Dysphagia assessment and management now...

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