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* Applicant's Name: Last
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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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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
Ears, Nose & Throat
Scrub
Circulate
Acoustic Neuroma
Caldwell-Luc
Closed Reduction Nasal Fracture
Commando Procedure
Ear Cases:
Mastoidectomy
Myringotomy
Stapedectomy
Tympanoplasty
Ethymoidectomy
Excision Salivary Gland Tumor
Fenestration Procedure
Frontal Flap Sinus Procedure
Glossectomy
Laryngectoy
Maxillary Advancement with Hip Graft
Nasal Polypectomy
Open Reduction Facial Fractures
Open Reduction Tripod Fractures
Parotidectomy
PE Tube Insertion
Pharyngeal Flap Procedure
Radical Neck Dissection
Ranulectomy
Selective Osteotomy of Maxilla/Mandible
Sinusotomy
Submucous Resection
Tonsillectomy
Tracheostomy
Vocal Cord Stripping
Endoscopic Procedures
Bronchoscopy
Colonoscopy
Culdoscopy
Cystoscopy
Esophagoscopy
Gastroscopy
Laryngoscopy
Laparoscopy:
Appendectomy
Cholecystectomy/Cholangiogram
Colon Resection
Herniorrhaphy
Hysterectomy
Mediastinocopy
Sigmoidoscopy
Suspension Micro-laryngoscopy
Equipment
Aquamatic K Thermia Unit
Arthroscopy Cameras
Blood Warmer
Bovie Electrosurgical Unit
Cardiac Monitor & Pacemaker
Electrodyn
Cavitran - Coopervision
Cell Saver
Cry-Opthalmic Unit
Dermatomes
Disposable Bovie Plates
Drills
Dual Tract Lights
Emerson Thoracic Pump
Ethylene Oxide Sterilizer
Eye Magnet
Fiber Optic Luminators
Flash Autoclave
Fluid Pumps
Kiddie Pneumatic Tourniquet
Kreiselman Resuscitatior
Laser
Nerve Stimulator
Nitrous Oxide Bank
Ohio Suction Units
Operation Microscope
Set Synthes Compression
Steri-Vac Aeration Cabinet
Ultrasonic Cleaner - AM
Vac-Pac Positioner
Vacuum Curettage
Washer Sterilizer - AMSCO
General Surgery
Abdominal - Perineal Resection
Adrenalectomy
Anal Fissurectomy
Colectomy
Colostomy/Ileostomy
Gastrectomy
Hepatic Resection
Hernia Repair
Hydrocelectomy
Leveen-Peritoneal Shunt
Lumbar Sympathectomy
Minor Case Set-Up (Breast Biopsies, Hernias)
Nissen Fundoplication
Pancreatectomy/Pancreatogram
Pilonidal Cystectomy
Portal Caval Shunt
Radical Mastectomy
Rectal Cases
Saphenous Vein Ligation and Stripping
Splenectomy
Staging Laprotomy
Thyroglossal Duct Cyst Excision
Thyroidectomy
Vagotomy
Whipple Procedure
Gynecology
Abdominal Hysterectomy
C-Sections
Colpotomy
Dilation and Curettage
Laporoscopy
Marshall Marchetti
Marsupialization Bartholin Cyst
Pelvic:
Anterior
Posterior
Total
Radical Hysterectomy
Radium Insertion
Salpingoplasty
Shirodkar Operation
Suction Curettage
Tubal Ligation
Tuboplasty/Microscope
Vaginal Hysterectomy
Vaginal Reconstruction
Vaginectomy
Vulvectomy
Neurology
Burr Holes (Subdural Hematoma)
Cartoid Endarterectomy
Cartoid Ligation
Cervical Laminectomy
Cervical Sympathectomy
Clipping of Intracranial Aneurysm
Craniectomy for Decompression Fracture
Cranioplasty
Craniotomy for Tumor Excision
Crutchfield Tong Insertion
Exterior Cervical Fusion
Hypophysectomy
Laminectomy
Lumbar Lamine
Meningocele Repair
Transsphenoid Hypothypectomy
Ulna Nerve Transplant
VA & VP Shunt
Ventricular Procedures
Vinke Tong Insertion
Opthalmology
Cataract Extraction
Corneal Transplant
Dacryocystectomy
Dacryocystorhinostomy
Diathermy Operation
Enucleation
Iredectomy
Lid and Muscle Procedures
Orbital Implant
Pterygium Repair
Recession Resection
Repair Orbital Blowout Fracture
Retina Detach
Vitrectomy
Oral
Closed Reduction Facial Fractures/Wiring
Extraction of Deciduous Teeth
Extraction of Impacted Molars
Excision Odontoma
Fractured Jaws, Mandibular, and Zagomatic
LeFort Osteotomies
Maxillary Procedure with Graft
TMJ with Arthroplasty
TMJ Exploration
Orthopedics
Achilles Tendon Repair
Amputation/Leg, Arm
Anterior Cruciate Ligament Repair
Application Halo Traction
Application of Spica Cast
Arthroscopic Surgery
Capsulorrhaphy
Closed Reduction Fracture
Cup Arthroplasty/Insertion Prosthesis
Dwyer Anterior Fusion
Excision of Olecranon Bursa
Fracture Table Use
Hand Surgery with Implants
Harrington Rod Insertion
Heel Cord Lengthening
I.M. Rodding
Insertion of Swanson Finger Prosthesis
Nailing Procedures
Open Reduction Fracture
Patellectomy
Putti Platt/Bankart Procedure
Reduction with compression Sets
Sharrad Procedure
Spinal Fusion
Tendon Implants
Total Joint Replacement
Zimmer Hip Compression
Pediatrics
Cleft Lip/Palate Repair
Inguinal Hernia
Lap
