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Date
* Applicant's Name: Last
Middle Initial
* First
To ArdorHealthSolutions Healthcare Professionals:
The following checklist is a profile used to assess your clinical proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given in this checklist. Please rate your ability as accurately as possible by checking the appropriate box.
The information I have given here is true and accurate to the best of my knowledge. In addition, I also authorize ArdorHealthSolutions to release this skills checklist to client institutions of ArdorHealthSolutions in relation to my employment with that institution.
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* Date
Please Mark Your Level of Experience 1 - No Experience: Theory / Observed Only 2 - Intermittent Experience: < 5 Times Per Year; Needs Review 3 - Moderate Experience: > 5 Times Per Year; May Need Minimal Resource 4 - Competent: Performs on Daily or Weekly Basis; Proficient
Infectious Disease
1
2
3
4
Assessment and care of Patient with:
Administration of Chemotherapy
AIDS/ARC
Anemia
Bone Marrow Transplant
Hepatitis
Immuno Compromised Condition
Inpatient Chemotherapy
Inpatient Hospice
Lukemia
Lyme Disease
Pain Management
Radiation Therapy
Ratiation Implant
Fever Management
Interpretation of Lab Results
Isolation - Disease Specific:
Blood/Body Fluid
Contact
Drainage / Secretion
Enteric
Respirator
Strict
Intravenous Therapy
Antibiotics Administration
Blood:
Albumin
Packed
Plasma
Platelets
Whole
Blood Drawing:
Central
Implanted
CVP Line Measurement
Care of Implanted Vascular Access Devices (Infusaport, Portacath, Mediport)
Discontinuing:
Peripheral
Dose Calculations
Flushing
IV Administration:
Chemotherapy
TPN
Intralipids
Insertion of:
Angiocath
Butterfly
Heparin Lock
Intra Cath
Mixing
PICC Line Insertion
Adult
Pediatric
Piggybacking
Site Care:
Central (Hickman/Broviac)
Use of Infusion Pumps (IVAX, IMED, Etc.)
Use of Multiple Lumen Catheters
Use of PCA/CADD
Medication Administration
Administers Medication via:
Documentation on MAR
Dose Calculation
IV Drip Medications
Antibiotics
Narcotics
Knowledgable of Drug Actions/Interactions/Side Effects
Narcotic Administration:
Verification of Wastage
Oral
Parenteral
Intradermal
Intramuscular
Z-Track
Intravenous
Hickman-Broviac Catheter
Rectal
Subcutaneous
Sublingual
Topicale
Unit Dose
Oncology
Assessment of:
Nutritional Status
Pain Control
Leukemia
Radiation Implant
Sickle Cell Disease
Interpretation of Lab Work
Medications:
Chemotherapy Certifications
Orthopedics
Circulation
Gait
Range of Motion
Skin
Care of Patient with:
Amputation
Arthroscopic Surgery
Cast
Osteoporosis
Pinned Fractures
Rheumatc/Arthritic Disease
Total Hip Replacement
Total Knee Replacement
Continuous Passive Motion
