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★★★★−
Standard Precautions: 0★★★★−
Isolation Precautions: 0★★★★−
Pediatric Respiratory/Cardiac Arrest: 0★★★★−
Adult Respiratory/Cardiac Arrest: 0★★★★−
Crash Carts: 0★★★★−
Defibrillators: 0★★★★−
Automated Med Dispensing Systems: 0★★★★−
List Types:
Care Planning & Discharge Planning: 0★★★★−
Patient/Family Education: 0★★★★−
Electronic Documentation: 0★★★★−
Patient Assessment (Obtain Patient History): 0★★★★−
IV Pumps: 0★★★★−
Chemistry Interpretation: 0★★★★−
Radiation Safety and Environment: 0★★★★−
Radiation Safety Equipment: 0★★★★−
Sterile and Aseptic Technique: 0★★★★−
Obtaining Vital Signs: 0★★★★−
Transfer of Patient: 0★★★★−
Monitoring/Recording Cases: 0★★★★−
Assessment of Cardiac Rhythm: 0★★★★−
Coagulation Interpretation: 0★★★★−
Blood Glucose: 0★★★★−
BUN/Creatinine/GFR: 0★★★★−
Serum Electrolytes: 0★★★★−
Hematoma Recognition/Management: 0★★★★−
Radial/Brachial/Femoral/Pedal Pulse Checks: 0★★★★−
Set Up Oxygen Delivery Systems (cannula, ambu): 0★★★★−
Pulse Oximetry: 0★★★★−
Assess lung sounds: 0★★★★−
Rate and Work of Breathing: 0★★★★−
Suction Equipment: 0★★★★−
X-Ray: 0★★★★−
CT without contrast: 0★★★★−
CT with contrast: 0★★★★−
CT angiogram: 0★★★★−
Ultrasound: 0★★★★−
MRI: 0★★★★−
Mammography: 0★★★★−
PET/CT: 0★★★★−
Radiation Therapy: 0★★★★−
Gamma Imaging: 0★★★★−
Fluoroscopy: 0★★★★−
Hyperbaric Oxygen Chamber: 0★★★★−
TAVR: 0★★★★−
Anaphylaxis: 0★★★★−
Vasovagal Response: 0★★★★−
Embolism: 0★★★★−
IV Insertion: 0★★★★−
Vascular Access Devices (Port, AV Fistulas): 0★★★★−
Assess IV Site: 0★★★★−
Port access kit: 0★★★★−
Glucometers: 0★★★★−
EPOC machines: 0★★★★−
Obtaining Venous Lab Draws: 0★★★★−
Contrast Administration: 0★★★★−
Anticoagulants: 0★★★★−
Analgesia: 0★★★★−
Sedation: 0★★★★−
Administration of IM and SQ Medications: 0★★★★−
Administration of PO Medications: 0★★★★−
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