Personal Information

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Proficiency Scale

1: No experience

2: Need Training

3: Able to perform with supervision

4: Able to perform independently

Staff Minimze Risk of Exposure:

During Administration

During Preparation

Care of Oncological Patient

Gastrointestinal Tract

Genitourinary

Cystitis

Renal Toxicity

Age Specific Competency

Able to ensure a safe and caring environment for the specific age groups indicated below; able to communicate and instruct patients from various age groups; able to evaluate age-appropriate behavior and skills.

Please list any additional areas of expertise below:

The information represented above is true and correct to the best of my knowledge. I also authorize Tricehealthcare to share the above skills checklist with its hospital clients

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

Medication / IV Therapy

Classification of Neoplasms

Cancer Therapy

Surgical Intervention

Antineoplastic Agents

Alkylating Agents:

Antimetabolites:

Brachytherapy (Sealed Sources):

Radiopharmaceutical (Unsealed Sources)

Hormonal Antineoplastics:

Staff Minimze Risk of Exposure:

Side Effects (Recognition / Management)

Hematopoietic

Gastrointestinal

Antineoplastic Antibiotics:

Plant Alkaloids:

Nutrition

Oncology Health Care Settings

Care of Oncological Patient

Integumentary

Genitourinary

Cardiovascular

Neurologic

Pulmonary

Reproductive

Emergencies

Family / Psychosocial Needs

Age Specific Competency

Age Specific Competency