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 (birth–30 days): 0★★★★−
Infant (30 days–1 year): 0★★★★−
Toddler (1–3 years): 0★★★★−
Preschooler (3–5 years): 0★★★★−
School Age (5–12 years): 0★★★★−
Adolescents (12–18 years): 0★★★★−
Young Adults (18–39 years): 0★★★★−
Middle Adults (39–64 years): 0★★★★−
Older Adults (64+ years): 0★★★★−
Elderly Adults (over 79+ years): 0★★★★−
Venipuncture/IV Placement: 0★★★★−
Standard Precautions: 0★★★★−
Isolation Precautions: 0★★★★−
Pediatric Respiratory/Cardiac Arrest: 0★★★★−
Adult Respiratory/Cardiac Arrest: 0★★★★−
Crash Carts: 0★★★★−
Defibrillators: 0★★★★−
Quality Control Equipment: 0★★★★−
Daily Surveys/Wipe Testing: 0★★★★−
Hot Lab Management Dose Calibrators: 0★★★★−
Hot Lab Management Generators: 0★★★★−
National Patient Safety Goals: 0★★★★−
Universal Protocol Procedures/Core Measures: 0★★★★−
Infection Prevention: 0★★★★−
Age Specific/Population-Based Care: 0★★★★−
Fall Risk Assessment/Prevention: 0★★★★−
Nuclear Med Imaging Systems: 0★★★★−
Adult Acute Care: 0★★★★−
Adult Outpatient: 0★★★★−
Pediatric Inpatient/Outpatient: 0★★★★−
Nuclear Cardiology: 0★★★★−
Arteriogram/Radionuclide: 0★★★★−
Abscess Localization Whole Body: 0★★★★−
Abscess Localization Limited: 0★★★★−
CCK/Ejection Fraction: 0★★★★−
Cisternogram: 0★★★★−
CSF Leak Localization: 0★★★★−
Gallium Scan: 0★★★★−
Gastric Emptying: 0★★★★−
GI Bleed: 0★★★★−
HIDA Scan: 0★★★★−
Indium 111 WBC Scan Whole Body: 0★★★★−
Indium 111 WBC Scan Limited: 0★★★★−
Injection-Lymphatic: 0★★★★−
Lymphatic Scan-Melanoma: 0★★★★−
Meckels Scan: 0★★★★−
HIDA with Morphine: 0★★★★−
MUGA Scan: 0★★★★−
Radiopharmaceutical Prep: 0★★★★−
Resting and Exercise Radionuclide Angiogram: 0★★★★−
Renagram: 0★★★★−
Parathyroid: 0★★★★−
Salivary Glands: 0★★★★−
Ventricular Shunt: 0★★★★−
Zevalin Treatment: 0★★★★−
Hyperthyroid Treatment: 0★★★★−
I-131 Therapy Thyroid Ablation: 0★★★★−
Pain Therapy: 0★★★★−
Whole Body Bone Scan: 0★★★★−
3 Phase Bone Scan: [rating 3phase-bone]
Limited Bone Scan: 0★★★★−
Cerebral Blood Flow: 0★★★★−
Liver/Spleen Scan: 0★★★★−
Liver Scan-Hemangioma: 0★★★★−
Liver Flow: 0★★★★−
DTPA Aerosol: 0★★★★−
Perfusion: 0★★★★−
Ventilation/Perfusion: 0★★★★−
Renal Flow With Lasix: 0★★★★−
Renal Flow/Function: 0★★★★−
Renal Flow Three Phase: 0★★★★−
Renal Flow Captopril: 0★★★★−
Captopril Shunt: 0★★★★−
Thyroid Cancer Survey: 0★★★★−
Uptake Scan: 0★★★★−
I 123 Scan: 0★★★★−
Whole Body I 131 or Octreoscan Tumor Localization: 0★★★★−
Limited I 131 or Octreoscan Tumor Localization: 0★★★★−
NM Spect Bone: 0★★★★−
NM Spect Brain: 0★★★★−
NM Spect Liver: 0★★★★−
NM Spect Liver w/Flow: 0★★★★−
NM Spect Renal: 0★★★★−
2 Day Rest/Stress MIBI: 0★★★★−
Exercise/Rest/Stress MIBI: 0★★★★−
Exercise: 0★★★★−
Pharmacological Stress: 0★★★★−
Thallium/Viability: 0★★★★−
Ambra Health: 0★★★★−
Sectra: 0★★★★−
Infinitt: 0★★★★−
IBM Merge: 0★★★★−
McKesson: 0★★★★−
Philips: 0★★★★−
FujiFilm: 0★★★★−
Impax: 0★★★★−
Centricity: 0★★★★−
Carestream Vue: 0★★★★−
Clarity: 0★★★★−
eRad PACS: 0★★★★−
Syngo: 0★★★★−
Intellaviewer: 0★★★★−
Epic Radiant: 0★★★★−
Novo Rad: 0★★★★−
Siemens Computer: 0★★★★−
Siemens Diacam: 0★★★★−
Siemens Orbiter Camera: 0★★★★−
Siemens Spect: 0★★★★−
ADAC Computer: 0★★★★−
ADAC Camera: 0★★★★−
3D Reconstruction Packet: [rating 3d]
Centiview: 0★★★★−
Digital Computer: 0★★★★−
Elscint Camera: 0★★★★−
GE LFOV: 0★★★★−
GE Star Cam SPECT: 0★★★★−
Genesis: 0★★★★−
Hitachi: 0★★★★−
Konica Minolta: 0★★★★−
Please list EMR systems you have experience with: