Personal Information

*Please fill the email ID correctly for successful submission

Proficiency Scale:

1 = No experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Pharmacy Software Systems

Etreby

IASRx

McKesson - 3PM

McKesson - Pharmserv

Meditech

NDC

OPUS-ISM

OSCOR

PDX

PharmNet

Pharmtrak

PROScript 2000

QS1

Renlar

Rescot-Omni-DX

Rx-Link

Speed Script

TechRx

WinPharm

Disease State Management

AIDS/HIV

Anticoagulation

Asthma

Cardiovascular Disease

Chemotherapy

Cystic Fibrosis

Depression

Diabetes

Dyslipidemia

Hormone Replacement Therapy

Hypertension

Osteoporosis

Pain Management

Smoking Cessation

Transplant

Age Specific Competencies

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

^*Please enter information you feel is important or necessary to give further explanation for information provided above:

I hereby certify that ALL information I have provided to Tricehealthcare on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

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:

Practice Settings/Experience

Pharmacy Software Systems

Automation

Disease State Management

Clinical and Job related Experience

Age Specific Competencies

Pharmacokinetic Dosing