Your name
Your Email
Last 4 Of SSN
Date
E-Signature
I hereby certify that ALL information I have provided 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.
Newborn/Neonate (birth to 30 days) 0★★★★−
Infant (1 month to 1 year) 0★★★★−
Toddler (1 year to 3 years) 0★★★★−
Preschooler (3 years to 5 years) 0★★★★−
School Age Child (5 years to 12 years) 0★★★★−
Adolescents (12 years to 18 years) 0★★★★−
Young Adults (18 years to 39 years) 0★★★★−
Middle Adults (39 years to 64 years) 0★★★★−
Older Adults (64 years to 79 years) 0★★★★−
Elderly Adults (over 79+ years) 0★★★★−
Respiratory 0★★★★−
Cardiovascular 0★★★★−
Neurological 0★★★★−
Glasgow Coma Scale 0★★★★−
Gastrointestinal 0★★★★−
Psychological 0★★★★−
Pressure Area Care 0★★★★−
Dietary Requirements 0★★★★−
Fluid Balance Charts 0★★★★−
12 Lead 0★★★★−
Arrhythmias 0★★★★−
Lead Placement 0★★★★−
Interpretation 0★★★★−
Blood Gases 0★★★★−
Blood Chemistry 0★★★★−
Cardiac Enzymes 0★★★★−
CBC 0★★★★−
Coagulation studies 0★★★★−
Electrolytes 0★★★★−
Urine dipstick 0★★★★−
Auscultation 0★★★★−
Doppler 0★★★★−
Automatic BP cuff 0★★★★−
Palpation 0★★★★−
Swan-Ganz cath insertion assist 0★★★★−
Swan-Ganz cath care 0★★★★−
MAP 0★★★★−
CVP 0★★★★−
PAWP/Wedge/PA 0★★★★−
Cardiac Output 0★★★★−
Cardiac Index 0★★★★−
SVO2 0★★★★−
Arterial line insertion assist 0★★★★−
Arterial line care 0★★★★−
SVR/PVR Calculation 0★★★★−
Pulmonary Artery Pressures 0★★★★−
Central Venous Pressures 0★★★★−
Blood via femoral artery 0★★★★−
Blood via radial artery 0★★★★−
Blood via arterial line 0★★★★−
Blood via central line 0★★★★−
Blood via venous line 0★★★★−
Cultures 0★★★★−
Sputum 0★★★★−
Urine 0★★★★−
ET tube - closed 0★★★★−
ET Tube - open 0★★★★−
Nasal-pharyngeal 0★★★★−
Tracheostomy 0★★★★−
Oral/Yankauer 0★★★★−
Cardiac Monitor 0★★★★−
Centrifuge 0★★★★−
Defibrillator 0★★★★−
Glucometer 0★★★★−
Hypo/hyperthermia blankets 0★★★★−
Infusion pumps (specific brands) 0★★★★−
Apnea monitor 0★★★★−
Pulse Oximeter 0★★★★−
Vigileo 0★★★★−
ECMO Machine 0★★★★−
CRRT machine 0★★★★−
High frequency oscillatory ventilation 0★★★★−
Specialty Beds 0★★★★−
CPAP 0★★★★−
High frequency jet 0★★★★−
Peep 0★★★★−
T-Piece 0★★★★−
Tidal Volume 0★★★★−
IMV 0★★★★−
Neuro Assessment/Neuro Vitals 0★★★★−
ICP Monitoring 0★★★★−
Seizure precautions 0★★★★−
Acute/Chronic CVA 0★★★★−
Transient ischemic attack 0★★★★−
Hemorrhagic Stroke 0★★★★−
Ischemic stroke 0★★★★−
Assessment of breath sounds 0★★★★−
Assist with set-up maintenance of chest tubes 0★★★★−
Use of chest drainage systems 0★★★★−
Assist with intubation/extubation 0★★★★−
Ambu Bagging technique 0★★★★−
Administer oxygen (nasal cannula, mask, endotracheal) 0★★★★−
Assist with and setting up for bronchoscopy 0★★★★−
Assessment of bowel sounds 0★★★★−
Identification of abnormalities 0★★★★−
Stool tests 0★★★★−
Insert/Maintain Feeding tubes/NG Tubes 0★★★★−
Identification of NG/tube feeding placement 0★★★★−
Administration of tube feedings 0★★★★−
Checking tube feeding residuals 0★★★★−
Care of ostomy patient 0★★★★−
Care of patient on total parenteral nutrition 0★★★★−
Ability to insert/maintain urinary drainage tubes 0★★★★−
Administer peritoneal dialysis 0★★★★−
Administer CRRT 0★★★★−
Administer Hemodialysis 0★★★★−
Care of patient receiving dialysis 0★★★★−
Assessment of fluid and electrolyte problems 0★★★★−
Amiodarone 0★★★★−
Atropine 0★★★★−
Digitalis 0★★★★−
Dobutamine 0★★★★−
Dopamine 0★★★★−
Epinephrine 0★★★★−
Heparin 0★★★★−
Insulin 0★★★★−
Isuprel 0★★★★−
Lidocaine 0★★★★−
Nipride 0★★★★−
Nitroglycerin 0★★★★−
Procainamide 0★★★★−
Sodium Bicarbonate 0★★★★−
Thrombolytics 0★★★★−
Verapamil 0★★★★−
Mannitol 0★★★★−
Pain assessment using pain scales 0★★★★−
Epidural analgesia 0★★★★−
IV conscious sedation 0★★★★−
Patient controlled analgesic (PCA) 0★★★★−
Narcotic Agents 0★★★★−
Non-narcotic agents 0★★★★−
Non-pharmacological measures 0★★★★−
Intra aortic balloon pump 0★★★★−
Albumin Transfusion 0★★★★−
Auto infusion 0★★★★−
Cryoprecipitate transfusion 0★★★★−
Fresh Frozen Plasma (FFP) Transfusion 0★★★★−
Packed RBCs Transfusion 0★★★★−
Whole Blood transfusion 0★★★★−
Platelets transfusions 0★★★★−
Intracranial pressure monitoring 0★★★★−
Central line care 0★★★★−
Hyperalimentation 0★★★★−
Intralipids 0★★★★−
Isolation Procedures 0★★★★−
Lumbar Puncture (assist with) 0★★★★−
Nerve Stimulators 0★★★★−
A/V Fistula care 0★★★★−
Bronchoscopy 0★★★★−
Case Care 0★★★★−
Chest physiotherapy 0★★★★−
Bladder irrigation 0★★★★−
Gastric Lavage/Gavage 0★★★★−
Athena 0★★★★−
Greenway Primesuite 0★★★★−
Allscripts 0★★★★−
Care360 0★★★★−
CPSI 0★★★★−
eCLinicalWorks 0★★★★−
Eclipsys 0★★★★−
EPIC 0★★★★−
MACLAB 0★★★★−
McKesson/Paragon 0★★★★−
Meditech 0★★★★−
PACS 0★★★★−
Quadramed 0★★★★−
Sorian 0★★★★−
