Personal Information

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Legends

1 = No experience; Theory/observed only

2 = Limited competency; < 5 times per year; Needs supervision

3 = Acceptable competency; > 5 times per year

4 = Competent; Performs on a daily or weekly basis; Proficient

Cardiovascular Interpretation of lab results

Cardiac enzymes & isoenzymes

Coagulation studies

Renal / Genitourinary Equipment usage & procedure

Bladder irrigation

Pain Management

Assessment of pain level/tolerance

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I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Legends

Cardiovascular Assessment

Cardiovascular Interpretation of lab results

Cardiovascular Equipment usage & procedure

Cardiovascular Monitoring

Cardiovascular Pacemaker

Cardiovascular Assisting with

Cardiovascular Care of the patient with:

Cardiovascular Medications

Pulmonary

Pulmonary Equipment usage & procedure

Pulmonary Airway management devices

Pulmonary Assist with

Pulmonary O2 therapy & med delivery systems

Pulmonary Equipment usage & procedure

Pulmonary Care of the patient with

Neurological Assessment

Neurological Equipment usage & procedure

Neurological Care of the patient with:

Neurological Medications

Gastrointestinal

Gastrointestinal Equipment usage & procedure

Gastrointestinal Equipment usage & procedure

Gastrointestinal Care of the patient with

Gastrointestinal Medications

Renal / Genitourinary

Renal / Genitourinary Equipment usage & procedure

Renal / Genitourinary Insertion & care of:

Renal / Genitourinary Care of the patient with

Endocrine / Metabolic

Endocrine / Metabolic Equipment usage & procedure

Endocrine / Metabolic Care of the patient with:

Wound Management Assessment of:

Wound Management Equipment usage & procedure

Wound Management Care of the patient with:

Phlebotomy / IV Therapy Equipment usage & procedure

Phlebotomy / IV Therapy Care of the patient with

Pain Management

Pain Management Care of the patient with:

Miscellaneous Care of the patient with:

Age Specific Practice Criteria

EMR