Personal Information

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Proﬁciency Scale:

0 = No Experience

1 = Some Experience

2 = Intermittent Experience

3 = Experienced

4 = Very Experienced

REGULATORY

CMS/Medicare

HEDIS Measures

Core Measures

Medicaid/Medical

DRG

ICD-10 Coding

CPT

RAPS

OBRA

MDS

PROFESSIONAL KNOWLEDGE AND SKILLS

National Patient Safety Goals

Age Specific Care

Population Based Care

Electronic Documentation

Please list any areas of expertise below

I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Proﬁciency Scale:

WORK SETTING

REGULATORY

PROCESSES

PROFESSIONAL KNOWLEDGE AND SKILLS

PROFICIENCY SCALE