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★★★★−
Use of contrast agents: 0★★★★−
IV insertion: 0★★★★−
IV maintenance: 0★★★★−
Setup errors: 0★★★★−
Technical artifact: 0★★★★−
M-Mode: 0★★★★−
Color flow: 0★★★★−
Real time: 0★★★★−
Stress echo: 0★★★★−
Pediatric echocardiogram: 0★★★★−
Adult echocardiogram: 0★★★★−
Doppler: 0★★★★−
Dobutamine stress echocardiogram: 0★★★★−
TEE (transesophageal echocardiography): 0★★★★−
Duplex: 0★★★★−
Arterial peripheral upper extremity: 0★★★★−
Arterial peripheral lower extremity: 0★★★★−
Arterial peripheral stress/pressure testing: 0★★★★−
Carotid artery: 0★★★★−
Vertebral artery: 0★★★★−
Subclavian artery: 0★★★★−
Venous peripheral upper extremity: 0★★★★−
Venous peripheral lower extremity: 0★★★★−
Quality control of equipment: 0★★★★−
Recognition of malfunctions: 0★★★★−
Transducer selection: 0★★★★−
Image annotation: 0★★★★−
Patient variables: 0★★★★−
Criteria for diagnostic quality: 0★★★★−
Universal precautions: 0★★★★−
Disinfection and cleaning: 0★★★★−
Flow Studies: 0★★★★−
Photoplethysmography: 0★★★★−
Strain gauge and Pneumoplethysmography: 0★★★★−
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★★★★−
Please list the EMR systems you have used:
