Your name
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Last 4 Of SSN
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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.
Young Adults (18 years to 39 years): 0★★★★−
Middle Adults (39 years to 64 years): 0★★★★−
Older Adults (64+ years): 0★★★★−
Hospital within Hospital: 0★★★★−
Free-Standing LTAC: 0★★★★−
Admission: 0★★★★−
Advance Directives: 0★★★★−
Collect Appropriate Data: 0★★★★−
Organ/Tissue Donation: 0★★★★−
Patient and Family Teaching: 0★★★★−
Electronic Medical Records: 0★★★★−
Abnormal Heart Sounds/Murmurs: 0★★★★−
Capillary Refill: 0★★★★−
Acute MI: 0★★★★−
Angina: 0★★★★−
Cardiac Arrest/CPR: 0★★★★−
Cardiomyopathy: 0★★★★−
Congestive Heart Failure: 0★★★★−
Pacemaker: 0★★★★−
AICD (Automatic Implanted Cardioverter/Defibrillator): 0★★★★−
Post Cardio-Thoracic Surgery: 0★★★★−
CVP Monitoring: 0★★★★−
Arterial Line: 0★★★★−
Cardiac Monitoring: 0★★★★−
BNP (Brain Natriuretic Peptide): 0★★★★−
Cardiac Enzymes and Isoenzymes: 0★★★★−
Coagulation Studies: 0★★★★−
Troponin: 0★★★★−
Adventitious Breath Sounds: 0★★★★−
Oxygenation Status: 0★★★★−
Rate and Work of Breathing: 0★★★★−
Acute Pneumonia: 0★★★★−
Chest Tube: 0★★★★−
COPD: 0★★★★−
Pulmonary Edema: 0★★★★−
Pulmonary Embolism: 0★★★★−
Tracheostomy: 0★★★★−
Tuberculosis: 0★★★★−
Pulse Oximetry: 0★★★★−
End Tidal CO2: 0★★★★−
ABGs: 0★★★★−
Level of Consciousness: 0★★★★−
Neuro Assessment: 0★★★★−
Reflex/Motor Deficits: 0★★★★−
Visual/Communication Deficits: 0★★★★−
Alzheimer's Disease: 0★★★★−
Coma: 0★★★★−
CVA/Stroke: 0★★★★−
Neuromuscular Disease: 0★★★★−
Seizure Disorder: 0★★★★−
Spinal Cord Injury: 0★★★★−
Traumatic Brain Injury: 0★★★★−
Halo Traction/Cervical Tongs: 0★★★★−
Nutritional Status: 0★★★★−
Bowel Sounds: 0★★★★−
GI Assessment: 0★★★★−
Abdominal Wounds: 0★★★★−
Bowel Obstruction: 0★★★★−
Colostomy: 0★★★★−
GI/Esophageal Bleeding: 0★★★★−
Hepatitis: 0★★★★−
Pancreatitis: 0★★★★−
Liver Failure: 0★★★★−
Cancer: 0★★★★−
Serum Amylase: 0★★★★−
Serum Ammonia: 0★★★★−
Liver Function Tests: 0★★★★−
Fluid Status: 0★★★★−
Acute Renal Failure: 0★★★★−
End Stage Renal Failure: 0★★★★−
Hemodialysis: 0★★★★−
Nephrostomy: 0★★★★−
Urinary Tract Infection: 0★★★★−
Suprapubic Cath: 0★★★★−
Fistula/Shunt: 0★★★★−
I &O Measurment: 0★★★★−
Fluid Balance: 0★★★★−
Serum Electrolytes: 0★★★★−
BUN and Creatinine: 0★★★★−
Diabetes: 0★★★★−
Blood Glucose: 0★★★★−
Pulse/Circulation Checks: 0★★★★−
Amputation: 0★★★★−
Joint Replacement: 0★★★★−
Skeletal/Skin Traction: 0★★★★−
Cast Care: 0★★★★−
HIV/AIDS: 0★★★★−
Treatment Side Effects - Chemo/Radiation: 0★★★★−
Sepsis: 0★★★★−
S/S Infection: 0★★★★−
Staging of Pressure Ulcers: 0★★★★−
Skin Assessment: 0★★★★−
Burns: 0★★★★−
Pressure Ulcers: 0★★★★−
Surgical Wounds and Drains: 0★★★★−
Statis Ulcers: 0★★★★−
Wounds: 0★★★★−
Skin Breakdown: 0★★★★−
Administer IM and SQ Meds: 0★★★★−
Administer PO Medications: 0★★★★−
Administer IVP Medications: 0★★★★−
Administer IVPB Medications: 0★★★★−
Administer IV Drips and Titration: 0★★★★−
Administer Meds per Feeding Tubes: 0★★★★−
Assess/Maintain IV: 0★★★★−
Heparin Lock: 0★★★★−
Vascular Access Device - Care/Maintenance: 0★★★★−
Peripheral IV Insertion: 0★★★★−
Administer Blood/Blood Products: 0★★★★−
Enteral Feeding Administration: 0★★★★−
TPN/Procalamine: 0★★★★−
Tube Feeding Pumps: 0★★★★−
Bolus Tube Feedings: 0★★★★−
NGT/SBFT Insertion: 0★★★★−
PEG/G-Tube: 0★★★★−
Nasal Cannula: 0★★★★−
Venti Mask: 0★★★★−
Non-Rebreather Mask: 0★★★★−
Ambu-Bag: 0★★★★−
Trach Collar: 0★★★★−
Portable Oxygen Ventilator (IMV, AC, PEEP): 0★★★★−
Assess Pain Level Tolerance: 0★★★★−
Functional Pain Goal: 0★★★★−
Epidural Analgesia: 0★★★★−
Patient Controlled Analgesia: 0★★★★−
Chest Tube Drainage Systems: 0★★★★−
Doppler: 0★★★★−
Dressing Changes: 0★★★★−
Drains (JP-Hemovac-Penrose): 0★★★★−
Suctioning (Oral-Naso-Pharnyx): 0★★★★−
Tracheostomy Care/Suctioning: 0★★★★−
Indwelling Urinary Catheter: 0★★★★−
Isolation: 0★★★★−
Wound Vac: 0★★★★−
Finger Stick: 0★★★★−
Butterfly Stick: 0★★★★−
Central-Line Blood Draw: 0★★★★−
Clean Catch Urine: 0★★★★−
Urine Catheter Culture Collection: 0★★★★−
Blood Cultures: 0★★★★−
Venipuncture: 0★★★★−
24 Hour Urine: [rating 24hr-urine]
Bedside Invasive Procedures: 0★★★★−
Bronchoscopy: 0★★★★−
Central Line Insertion: 0★★★★−
Chest Tube Insertion: 0★★★★−
Endotracheal Intubation: 0★★★★−
Procedure/Moderate Sedation: 0★★★★−
Please list the EMR systems you have used: