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Last 4 Of SSN
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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.
Abdominal Perineal Resection 0★★★★−
Appendectomy/Cholescystectomy 0★★★★−
Breast Biopsy 0★★★★−
Colon Resection/Surgery 0★★★★−
Gastrectomy 0★★★★−
Gastric Bypass/Roux-en-Y 0★★★★−
Hemorrhoidectomy 0★★★★−
Herniorrhaphy - Inguinal, Ventral, Femoral, Umbilical 0★★★★−
Laparoscopic General Surgeries 0★★★★−
Laparoscopic Nissen Fundoplication 0★★★★−
Mastectomy 0★★★★−
Splenectomy 0★★★★−
Thyroidectomy 0★★★★−
Aorta Repair 0★★★★−
Aorto-Bifemoral/Femoral-Pop Bypass Graft 0★★★★−
Cardiac Bypass Surgery 0★★★★−
Carotid Endarterectomy 0★★★★−
Endoscopic Vascular Procedures 0★★★★−
Femoral Popliteal Bypass Graft 0★★★★−
Laparascopic Cardiac Surgery 0★★★★−
Robotic Assisted Cardiac Surgery 0★★★★−
Valve Replacement/Repair 0★★★★−
Ventricular Assist Device 0★★★★−
Endoscopic Thoracic Procedures 0★★★★−
Esophagoogastrectomy 0★★★★−
Mediastinotomy/Sternotomy 0★★★★−
Thoracoscopy/Nuss Procedure 0★★★★−
Thoracotomy 0★★★★−
Total Joint Replacement 0★★★★−
Closed Reduction of Fracture 0★★★★−
External Fixator 0★★★★−
Cannulated Hip Screws 0★★★★−
Bankhart Procedure 0★★★★−
Birmingham Procedure 0★★★★−
Carpal Tunnel Release 0★★★★−
Arthroscopy 0★★★★−
Anterior Cruciate Ligament Reconstruction 0★★★★−
Craniotomy 0★★★★−
Steriotactic Guided Brain Biopsy 0★★★★−
Laminectomy 0★★★★−
Laparoscopic Anterior Laminectomy 0★★★★−
Insertion of Vagal Nerve Stimulator 0★★★★−
Insertion of VP Shunt 0★★★★−
Spinal Fusion 0★★★★−
Anterior Cervical Discectomy with Fusion 0★★★★−
Posterior Cervical Laminectomy 0★★★★−
Vasicaurethropexy 0★★★★−
Marshall Marchetti 0★★★★−
Circumcision 0★★★★−
Cystoscopy/Cystogram/Pyelogram 0★★★★−
Prostatectomy 0★★★★−
Nephrectomy 0★★★★−
Orchidectomy/Orchidopexy 0★★★★−
Ureterostomy 0★★★★−
Laparoscopic Assisted GU Procedures 0★★★★−
Robotic Assisted GU Procedures 0★★★★−
Abdominal Hysterectomy 0★★★★−
Anterior Posterior Repair 0★★★★−
C-Section 0★★★★−
D & C 0★★★★−
Laparoscopic Assisted Hysterectomy 0★★★★−
Laparotomy with Microtuboplasty 0★★★★−
Robotic Assisted GYN Procedures 0★★★★−
Vaginal Delivery 0★★★★−
Vaginal Hysterectomy 0★★★★−
Endoscopic ENT Procedures 0★★★★−
Laryngectomy 0★★★★−
Mastoidectomy 0★★★★−
Myringotomy with Insertion of Tubes 0★★★★−
Radical Neck 0★★★★−
Septoplasty 0★★★★−
Tonsillectomy & Adenoidectomy 0★★★★−
Tracheostomy 0★★★★−
Tympanoplasty 0★★★★−
Craniectomy 0★★★★−
Craniofacial Reconstruction 0★★★★−
Dental Surgery 0★★★★−
Leforte 1 Maxillary/Sagittal Osteotomy 0★★★★−
ORIF Mandibular Fracture 0★★★★−
Otoplasty 0★★★★−
Reconstruction of Ear 0★★★★−
Removal of Arch Bars 0★★★★−
Repair of Cleft Lip, Nose, Palate 0★★★★−
Rhinoplasty 0★★★★−
Blephoroplasty 0★★★★−
Breast Reconstruction with Implant 0★★★★−
Breast Reduction Mammoplasty 0★★★★−
Face Lift 0★★★★−
Mastectomy with Tram Flap Reconstruction 0★★★★−
Split Thickness Skin Graft 0★★★★−
Suction Lipectomy 0★★★★−
Heart 0★★★★−
Lung 0★★★★−
Liver 0★★★★−
Pancreas 0★★★★−
Eye 0★★★★−
Organ Donation 0★★★★−
Cataract Extraction with Implant 0★★★★−
Vitrectomy 0★★★★−
Scleral Buckle 0★★★★−
Cataract Aspiration; Anterior Vitrectomy 0★★★★−
Corneal Transplant 0★★★★−
Electrocautery (ESU) 0★★★★−
Laparoscopy Systems 0★★★★−
Neuro 0★★★★−
OR Fracture Tables 0★★★★−
List Types for OR Fracture Tables
Orthopedic Total Joint Systems 0★★★★−
Power Equipment 0★★★★−
Robotics Systems 0★★★★−
Spinal Fusion Instrumentation 0★★★★−
List Types for Robotics Systems
Malignant Hyperthermia Protocol 0★★★★−
Infection Prevention 0★★★★−
Isolation Precautions 0★★★★−
National Patient Safety Goals/Core Measures 0★★★★−
Universal Protocol 0★★★★−
Epic 0★★★★−
Picis 0★★★★−
Cerner 0★★★★−
Eclipsys 0★★★★−
McKesson 0★★★★−
Meditech 0★★★★−
Other Computerized System 0★★★★−
Computerized Physician Order Entry 0★★★★−
EMR Conversion YES YesNo
BLS
Certified Surgical Technologist (CST)
Certified Sterile Processing Technologist (CSPT)
Other: Specify
Infant (Birth - 1 year) 0★★★★−
Preschooler (ages 2-5 years) 0★★★★−
Childhood (ages 6-12 years) 0★★★★−
Adolescents (ages 13-21 years) 0★★★★−
Young Adults (ages 22-39 years) 0★★★★−
Adults (ages 40-64 years) 0★★★★−
Older Adults (ages 65-79 years) 0★★★★−
Elderly (ages 80+ years) 0★★★★−
