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–30 days): 0★★★★−
Infant (1 month–1 year): 0★★★★−
Toddler (1–3 years): 0★★★★−
Preschooler (3–5 years): 0★★★★−
School Age Child (5–12 years): 0★★★★−
Adolescents (12–18 years): 0★★★★−
Young Adults (18–39 years): 0★★★★−
Middle Adults (39–64 years): 0★★★★−
Older Adults (64–79 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★★★★−
Patient and Family Education: 0★★★★−
Electronic Documentation: 0★★★★−
List Types (Electronic Documentation):
Managing Food-Drug Interactions: 0★★★★−
Managing Food-Drug Timing: 0★★★★−
Managing Nutrition Therapy Complications: 0★★★★−
Develop Plan of Treatment: 0★★★★−
Document Refusal of Care: 0★★★★−
Document Non-Compliance: 0★★★★−
Determine Usual or Adjusted Body Weight: 0★★★★−
Determine Energy Requirements: 0★★★★−
Determine Protein Requirements: 0★★★★−
Determine Fluid Requirements: 0★★★★−
Determine Electrolyte Requirements: 0★★★★−
Determine Fat Requirements: 0★★★★−
Determine Micronutrient Requirements: 0★★★★−
Perform Nutrition Education: 0★★★★−
Perform Nutrition Assessments: 0★★★★−
Clinic Malnutrition: 0★★★★−
Poor Diet: 0★★★★−
Eating Difficulties: 0★★★★−
Marginal Malnutrition: 0★★★★−
Metabolic Demands: 0★★★★−
Nutrient Deficiencies: 0★★★★−
Assess Fluid Status: 0★★★★−
Kwashiorkor: 0★★★★−
Marasmus: 0★★★★−
Cachexia: 0★★★★−
Protein Calorie Malnutrition: 0★★★★−
Abdominal Wounds and Surgeries: 0★★★★−
Abnormal Bleeding: 0★★★★−
Acute MI: 0★★★★−
Acute Renal Failure: 0★★★★−
Alzheimer's Disease: 0★★★★−
Anorexia Nervosa: 0★★★★−
Aspiration: 0★★★★−
Bulimia: 0★★★★−
Cancer: 0★★★★−
Chronic Diarrhea: 0★★★★−
Trauma: 0★★★★−
Tuberculosis: 0★★★★−
Vented Patient: 0★★★★−
Wounds: 0★★★★−
Steroids: 0★★★★−
Immunosuppressants: 0★★★★−
Antineoplastics: 0★★★★−
Insulin: 0★★★★−
Diuretics: 0★★★★−
Blood Thinners: 0★★★★−
Laxatives: 0★★★★−
LFT's: 0★★★★−
Serum Ammonia: 0★★★★−
Serum Amylase: 0★★★★−
Cholesterol: 0★★★★−
BUN: 0★★★★−
Serum Electrolytes: 0★★★★−
Blood Glucose: 0★★★★−
Hematology: 0★★★★−
Creatinine: 0★★★★−
Albumin: 0★★★★−
Pre-Albumin: 0★★★★−
C-Reactive Proteins: 0★★★★−
Nitrogen Balance: 0★★★★−
Acid/Base Balance: 0★★★★−
Protein-Energy Balance: 0★★★★−
Vitamins and Minerals: 0★★★★−
Oral Diets: 0★★★★−
Enteral Nutrition: 0★★★★−
Parenteral Nutrition: 0★★★★−
Writing Orders for Nutrition: 0★★★★−
Intake and Output: 0★★★★−
Fluid Balance: 0★★★★−
Calorie Counts: 0★★★★−
Small Bowel Feeding Tubes: 0★★★★−
Gastrostomy Tubes: 0★★★★−
Jejunostomy Tubes: 0★★★★−
Hospital: 0★★★★−
Clinic: 0★★★★−
Long Term Care: 0★★★★−
Retirement Center: 0★★★★−
Hospice: 0★★★★−
Home Health: 0★★★★−
Research: 0★★★★−
Daycare: 0★★★★−
Correctional Facility: 0★★★★−
Restaurant: 0★★★★−
Public Health: 0★★★★−
Community Programs: 0★★★★−
RD/RDN: YesNo
List Types: