Name(Required)
First
Last
Age Specific Care
Proficiency Rating
Frequency Rating
Newborn/Neonate (birth - 30 days) *
Newborn/Neonate (birth - 30 days) proficiency(Required) Newborn/Neonate (birth - 30 days) frequency(Required) Infant (30 days - 1 year) *
Infant (30 days - 1 year) proficiency(Required) Infant (30 days - 1 year) frequency(Required) Toddler (1 - 3 years) *
Toddler (1 - 3 years) proficiency(Required) Toddler (1 - 3 years) frequency(Required) Preschooler (3 - 5 years) *
Preschooler (3 - 5 years) proficiency(Required) Preschooler (3 - 5 years) frequency(Required) School Age Child (5 - 12 years) *
School Age Child (5 - 12 years) proficiency(Required) School Age Child (5 - 12 years) frequency(Required) Adolescents (12 - 18 years) *
Adolescents (12 - 18 years) proficiency(Required) Adolescents (12 - 18 years) frequency(Required) Young Adults (18 - 39 years) *
Young Adults (18 - 39 years) proficiency(Required) Young Adults (18 - 39 years) frequency(Required) Middle Adults (39 - 64 years) *
Middle Adults (39 - 64 years) proficiency(Required) Middle Adults (39 - 64 years) frequency(Required) Older Adults (64+ years) *
Older Adults (64+ years) proficiency(Required) Older Adults (64+ years) frequency(Required) Elderly Adults (over 79+ years) *
Elderly Adults (over 79+ years) proficiency(Required) Elderly Adults (over 79+ years) frequency(Required)
General Skills
Proficiency Rating
Frequency Rating
Standard Precautions *
Standard Precautions proficiency(Required) Standard Precautions frequency(Required) Isolation Precautions *
Isolation Precautions proficiency(Required) Isolation Precautions frequency(Required) Pediatric Respiratory / Cardiac Arrest *
Pediatric Respiratory / Cardiac Arrest proficiency(Required) Pediatric Respiratory / Cardiac Arrest frequency(Required) Adult Respiratory / Cardiac Arrest *
Adult Respiratory / Cardiac Arrest proficiency(Required) Adult Respiratory / Cardiac Arrest frequency(Required) Crash Carts *
Crash Carts proficiency(Required) Crash Carts frequency(Required) Defibrillators *
Defibrillators proficiency(Required) Defibrillators frequency(Required) Care of Patient in Restraints *
Care of Patient in Restraints proficiency(Required) Care of Patient in Restraints frequency(Required) Pain Management *
Pain Management proficiency(Required) Pain Management frequency(Required) Automated Med Dispensing Systems *
Automated Med Dispensing Systems proficiency(Required) Automated Med Dispensing Systems frequency(Required) Care Planning & Discharge Planning *
Care Planning & Discharge Planning proficiency(Required) Care Planning & Discharge Planning frequency(Required) Patient / Family Education *
Patient / Family Education proficiency(Required) Patient / Family Education frequency(Required) Electronic Documentation *
Electronic Documentation proficiency(Required) Electronic Documentation frequency(Required) Patient Head to Toe Assessment *
Patient Head to Toe Assessment proficiency(Required) Patient Head to Toe Assessment frequency(Required)
Medication - Knowledge and use of
Proficiency Rating
Frequency Rating
Pouring from Stock Medications *
Pouring from Stock Medications proficiency(Required) Pouring from Stock Medications frequency(Required) Narcotic Administration *
Narcotic Administration proficiency(Required) Narcotic Administration frequency(Required) IV Push/ Drip Medications *
IV Push/ Drip Medications proficiency(Required) IV Push/ Drip Medications frequency(Required) Antibiotics *
Antibiotics proficiency(Required) Antibiotics frequency(Required) Oral *
Oral proficiency(Required) Oral frequency(Required) Topical *
Topical proficiency(Required) Topical frequency(Required) Otic *
Otic proficiency(Required) Otic frequency(Required) Rectal *
Rectal proficiency(Required) Rectal frequency(Required) Vaginal *
Vaginal proficiency(Required) Vaginal frequency(Required) Ophthalmic *
Ophthalmic proficiency(Required) Ophthalmic frequency(Required) Continuous Subcutaneous Infusion Pumps *
Continuous Subcutaneous Infusion Pumps proficiency(Required) Continuous Subcutaneous Infusion Pumps frequency(Required) Total Parenteral Nutrition (TPN) *
Total Parenteral Nutrition (TPN) proficiency(Required) Total Parenteral Nutrition (TPN) frequency(Required) Peripheral Parenteral Nutrition *
Peripheral Parenteral Nutrition proficiency(Required) Peripheral Parenteral Nutrition frequency(Required) Patient Controlled Analgesia (PCA) *
Patient Controlled Analgesia (PCA) proficiency(Required) Patient Controlled Analgesia (PCA) frequency(Required)
Phlebotomy/ IV Therapy
Proficiency Rating
Frequency Rating
Blood Draw - Peripheral *
Blood Draw - Peripheral proficiency(Required) Blood Draw - Peripheral frequency(Required) Blood Draw - Central Line/Port *
Blood Draw - Central Line/Port proficiency(Required) Blood Draw - Central Line/Port frequency(Required) Insertion, Care and Maintenance of Peripheral IV *
Insertion, Care and Maintenance of Peripheral IV proficiency(Required) Insertion, Care and Maintenance of Peripheral IV frequency(Required) Care and Maintenance of Central Lines *
Care and Maintenance of Central Lines proficiency(Required) Care and Maintenance of Central Lines frequency(Required) Care and Maintenance of Implanted Port- A- Cath *
Care and Maintenance of Implanted Port- A- Cath proficiency(Required) Care and Maintenance of Implanted Port- A- Cath frequency(Required) Mixing IVs *
Mixing IVs proficiency(Required) Mixing IVs frequency(Required) Regulating IVs *
Regulating IVs proficiency(Required) Regulating IVs frequency(Required) IV Infusion Pumps *
IV Infusion Pumps proficiency(Required) IV Infusion Pumps frequency(Required) Blood/Blood Product Administration *
Blood/Blood Product Administration proficiency(Required) Blood/Blood Product Administration frequency(Required)
Cardiac
Proficiency Rating
Frequency Rating
Recognizing Basic & Life- Threatening Dysrhythmia *
Recognizing Basic & Life- Threatening Dysrhythmia proficiency(Required) Recognizing Basic & Life- Threatening Dysrhythmia frequency(Required) Congestive Heart Failure *
Congestive Heart Failure proficiency(Required) Congestive Heart Failure frequency(Required) Pulse Checks *
Pulse Checks proficiency(Required) Pulse Checks frequency(Required) Use of Doppler Cardiac Monitors *
Use of Doppler Cardiac Monitors proficiency(Required) Use of Doppler Cardiac Monitors frequency(Required) Taking EKGs- 12 Lead *
Taking EKGs- 12 Lead proficiency(Required) Taking EKGs- 12 Lead frequency(Required) Use of Automatic BP Cuff (ie Dinamap) *
Use of Automatic BP Cuff (ie Dinamap) proficiency(Required) Use of Automatic BP Cuff (ie Dinamap) frequency(Required) CARE OF PATIENT WITH:
Heart Failure *
Heart Failure proficiency(Required) Heart Failure frequency(Required) CHF *
CHF proficiency(Required) CHF frequency(Required) MI *
MI proficiency(Required) MI frequency(Required) Arrhythmias *
Arrhythmias proficiency(Required) Arrhythmias frequency(Required) Hypertension *
Hypertension proficiency(Required) Hypertension frequency(Required) Hypotension *
Hypotension proficiency(Required) Hypotension frequency(Required) CAD *
CAD proficiency(Required) CAD frequency(Required) KNOWLEDGE AND USE OF:
Anticoagulants *
Anticoagulants proficiency(Required) Anticoagulants frequency(Required) Nitrates (Oral, Topical) *
Nitrates (Oral, Topical) proficiency(Required) Nitrates (Oral, Topical) frequency(Required) Antiarrhythmics (Oral) *
Antiarrhythmics (Oral) proficiency(Required) Antiarrhythmics (Oral) frequency(Required) Antihypertensives (Oral) *
Antihypertensives (Oral) proficiency(Required) Antihypertensives (Oral) frequency(Required)
Respiratory
Proficiency Rating
Frequency Rating
COPD *
COPD proficiency(Required) COPD frequency(Required) Asthma Exacerbation *
Asthma Exacerbation proficiency(Required) Asthma Exacerbation frequency(Required) Tracheostomy *
Tracheostomy proficiency(Required) Tracheostomy frequency(Required) Pneumonia *
Pneumonia proficiency(Required) Pneumonia frequency(Required) Emphysema *
Emphysema proficiency(Required) Emphysema frequency(Required) Pre/ Post Thoracic Surgery *
Pre/ Post Thoracic Surgery proficiency(Required) Pre/ Post Thoracic Surgery frequency(Required) Chest Tubes *
Chest Tubes proficiency(Required) Chest Tubes frequency(Required) Collection of Sputum Specimen *
Collection of Sputum Specimen proficiency(Required) Collection of Sputum Specimen frequency(Required) O2 Cannulas/ Masks *
O2 Cannulas/ Masks proficiency(Required) O2 Cannulas/ Masks frequency(Required) Non- rebreather Mask *
Non- rebreather Mask proficiency(Required) Non- rebreather Mask frequency(Required) Nebulizer Set- up/ Use *
Nebulizer Set- up/ Use proficiency(Required) Nebulizer Set- up/ Use frequency(Required) Incentive Spirometry *
Incentive Spirometry proficiency(Required) Incentive Spirometry frequency(Required) Chest PT *
Chest PT proficiency(Required) Chest PT frequency(Required) Suctioning (Oral/ Nasotracheal) *
Suctioning (Oral/ Nasotracheal) proficiency(Required) Suctioning (Oral/ Nasotracheal) frequency(Required) Suctioning (Tracheostomy Tube) *
Suctioning (Tracheostomy Tube) proficiency(Required) Suctioning (Tracheostomy Tube) frequency(Required) Ventilator Patient (Mouth Care, Suctioning, Ambu bag) *
Ventilator Patient (Mouth Care, Suctioning, Ambu bag) proficiency(Required) Ventilator Patient (Mouth Care, Suctioning, Ambu bag) frequency(Required) KNOWLEDGE AND USE OF:
Bronchodilators (Oral, IV, Inhaler) *
Bronchodilators (Oral, IV, Inhaler) proficiency(Required) Bronchodilators (Oral, IV, Inhaler) frequency(Required) Steroids *
Steroids proficiency(Required) Steroids frequency(Required)
Neuro
Proficiency Rating
Frequency Rating
Spinal Cord Injury - Acute *
Spinal Cord Injury - Acute proficiency(Required) Spinal Cord Injury - Acute frequency(Required) Spinal Cord Injury - Long Term *
Spinal Cord Injury - Long Term proficiency(Required) Spinal Cord Injury - Long Term frequency(Required) CVA/Stroke *
CVA/Stroke proficiency(Required) CVA/Stroke frequency(Required) Neuromuscular Disease *
Neuromuscular Disease proficiency(Required) Neuromuscular Disease frequency(Required) Alzheimer’s Disease *
Alzheimer’s Disease proficiency(Required) Alzheimer’s Disease frequency(Required) Wandering *
Wandering proficiency(Required) Wandering frequency(Required) Hallucinations *
Hallucinations proficiency(Required) Hallucinations frequency(Required) Anxiety *
Anxiety proficiency(Required) Anxiety frequency(Required) Agitation *
Agitation proficiency(Required) Agitation frequency(Required) Reality Orientation *
Reality Orientation proficiency(Required) Reality Orientation frequency(Required) Assessing Levels of Consciousness *
Assessing Levels of Consciousness proficiency(Required) Assessing Levels of Consciousness frequency(Required) Pupil Checks *
Pupil Checks proficiency(Required) Pupil Checks frequency(Required) Seizure Precautions *
Seizure Precautions proficiency(Required) Seizure Precautions frequency(Required) Stroke Precautions *
Stroke Precautions proficiency(Required) Stroke Precautions frequency(Required) Swallow Precautions *
Swallow Precautions proficiency(Required) Swallow Precautions frequency(Required) Assisting with Lumbar Puncture *
Assisting with Lumbar Puncture proficiency(Required) Assisting with Lumbar Puncture frequency(Required) Use of Hyper/Hypothermia Blanket *
Use of Hyper/Hypothermia Blanket proficiency(Required) Use of Hyper/Hypothermia Blanket frequency(Required) KNOWLEDGE AND USE OF:
Anticonvulsant *
Anticonvulsant proficiency(Required) Anticonvulsant frequency(Required) Sedative *
Sedative proficiency(Required) Sedative frequency(Required)
Sensory Deficits - Care of patients with
Proficiency Rating
Frequency Rating
Dentures *
Dentures proficiency(Required) Dentures frequency(Required) Hearing Aids *
Hearing Aids proficiency(Required) Hearing Aids frequency(Required) Hearing Loss *
Hearing Loss proficiency(Required) Hearing Loss frequency(Required) Prosthetic Eye *
Prosthetic Eye proficiency(Required) Prosthetic Eye frequency(Required) Contact Lens Care *
Contact Lens Care proficiency(Required) Contact Lens Care frequency(Required) Blindness *
Blindness proficiency(Required) Blindness frequency(Required) Macular Degeneration *
Macular Degeneration proficiency(Required) Macular Degeneration frequency(Required)
Gastrointestinal - Care of patients with
Proficiency Rating
Frequency Rating
Nasogastric Tubes (i.e. Salem Sump, Levine) *
Nasogastric Tubes (i.e. Salem Sump, Levine) proficiency(Required) Nasogastric Tubes (i.e. Salem Sump, Levine) frequency(Required) Nasointestinal Tubes (i.e. Cantor, Miller- Abbott) *
Nasointestinal Tubes (i.e. Cantor, Miller- Abbott) proficiency(Required) Nasointestinal Tubes (i.e. Cantor, Miller- Abbott) frequency(Required) Jejunostomy, Gastrostomy, Cecostomy Tubes *
Jejunostomy, Gastrostomy, Cecostomy Tubes proficiency(Required) Jejunostomy, Gastrostomy, Cecostomy Tubes frequency(Required) Colostomy, Ileostomy *
Colostomy, Ileostomy proficiency(Required) Colostomy, Ileostomy frequency(Required) Bronchoscopy Lung/Wedge Resection *
Bronchoscopy Lung/Wedge Resection proficiency(Required) Bronchoscopy Lung/Wedge Resection frequency(Required)
GI General
Proficiency Rating
Frequency Rating
Collection of Stool Specimens *
Collection of Stool Specimens proficiency(Required) Collection of Stool Specimens frequency(Required) Bowel Preparation and Cleansing Procedures *
Bowel Preparation and Cleansing Procedures proficiency(Required) Bowel Preparation and Cleansing Procedures frequency(Required) Administration of Tube Feedings via Flexible Tubes *
Administration of Tube Feedings via Flexible Tubes proficiency(Required) Administration of Tube Feedings via Flexible Tubes frequency(Required) Bowel Disimpaction *
Bowel Disimpaction proficiency(Required) Bowel Disimpaction frequency(Required) Bowel Retraining *
Bowel Retraining proficiency(Required) Bowel Retraining frequency(Required) Sitz Bath Treatments *
Sitz Bath Treatments proficiency(Required) Sitz Bath Treatments frequency(Required) Insertion and Checking Placement/Patency NG Tubes *
Insertion and Checking Placement/Patency NG Tubes proficiency(Required) Insertion and Checking Placement/Patency NG Tubes frequency(Required)
Endocrine - Care of patients with
Proficiency Rating
Frequency Rating
Diabetes *
Diabetes proficiency(Required) Diabetes frequency(Required) Hyper/Hypoglycemia *
Hyper/Hypoglycemia proficiency(Required) Hyper/Hypoglycemia frequency(Required)
Endocrine General
Proficiency Rating
Frequency Rating
Blood Glucose Monitoring *
Blood Glucose Monitoring proficiency(Required) Blood Glucose Monitoring frequency(Required) Performing Fingersticks *
Performing Fingersticks proficiency(Required) Performing Fingersticks frequency(Required) Use of Blood Glucose Meter Device *
Use of Blood Glucose Meter Device proficiency(Required) Use of Blood Glucose Meter Device frequency(Required) Use of Visual Blood Glucose Strips *
Use of Visual Blood Glucose Strips proficiency(Required) Use of Visual Blood Glucose Strips frequency(Required) KNOWLEDGE AND USE OF:
Single Type Insulin *
Single Type Insulin proficiency(Required) Single Type Insulin frequency(Required) Mixed Insulins *
Mixed Insulins proficiency(Required) Mixed Insulins frequency(Required) Insulin Infusion *
Insulin Infusion proficiency(Required) Insulin Infusion frequency(Required)
Renal/GU - Care of patients with
Proficiency Rating
Frequency Rating
Incontinence *
Incontinence proficiency(Required) Incontinence frequency(Required) Urinary Retention *
Urinary Retention proficiency(Required) Urinary Retention frequency(Required) UTI *
UTI proficiency(Required) UTI frequency(Required) Insertion of Foley Catheter - Female *
Insertion of Foley Catheter - Female proficiency(Required) Insertion of Foley Catheter - Female frequency(Required) Insertion of Foley Catheter - Male *
Insertion of Foley Catheter - Male proficiency(Required) Insertion of Foley Catheter - Male frequency(Required) Straight Catheterization - Male *
Straight Catheterization - Male proficiency(Required) Straight Catheterization - Male frequency(Required) Straight Catheterization - Female *
Straight Catheterization - Female proficiency(Required) Straight Catheterization - Female frequency(Required) Insertion of Suprapubic Catheter *
Insertion of Suprapubic Catheter proficiency(Required) Insertion of Suprapubic Catheter frequency(Required) Application of Condom Catheter *
Application of Condom Catheter proficiency(Required) Application of Condom Catheter frequency(Required) Urinary Diversion *
Bladder Retraining proficiency(Required) Bladder Retraining frequency(Required) Urinary Diversion *
Urinary Diversion proficiency(Required) Urinary Diversion frequency(Required) Bladder Irrigation (Continuous and Intermittent) *
Bladder Irrigation (Continuous and Intermittent) proficiency(Required) Bladder Irrigation (Continuous and Intermittent) frequency(Required) PERITONEAL DIALYSIS
Manual *
Manual proficiency(Required) Manual frequency(Required) Automatic Cycler Machine *
Automatic Cycler Machine proficiency(Required) Automatic Cycler Machine frequency(Required)
Orthopedic- Care of patients with
Proficiency Rating
Frequency Rating
Total Joint Replacement *
Total Joint Replacement proficiency(Required) Total Joint Replacement frequency(Required) Rheumatic/Arthritic Disease *
Rheumatic/Arthritic Disease proficiency(Required) Rheumatic/Arthritic Disease frequency(Required) Amputation *
Amputation proficiency(Required) Amputation frequency(Required) Fracture *
Fracture proficiency(Required) Fracture frequency(Required)
Orthopedic General
Proficiency Rating
Frequency Rating
Cast Care *
Cast Care proficiency(Required) Cast Care frequency(Required) CMS Checks *
CMS Checks proficiency(Required) CMS Checks frequency(Required) Traction - Skin *
Traction - Skin proficiency(Required) Traction - Skin frequency(Required) Traction - Skeletal *
Traction - Skeletal proficiency(Required) Traction - Skeletal frequency(Required) Range of Motion *
Range of Motion proficiency(Required) Range of Motion frequency(Required) Use of Assistive Devices *
Use of Assistive Devices proficiency(Required) Use of Assistive Devices frequency(Required) Application of Splints of Extremities *
Application of Splints of Extremities proficiency(Required) Application of Splints of Extremities frequency(Required) Continuous Passive Motion Machine (CPM) *
Continuous Passive Motion Machine (CPM) proficiency(Required) Continuous Passive Motion Machine (CPM) frequency(Required) Transfer Techniques *
Transfer Techniques proficiency(Required) Transfer Techniques frequency(Required) Use of Sliding Board *
Use of Sliding Board proficiency(Required) Use of Sliding Board frequency(Required) Gait Training/ Retraining *
Gait Training/ Retraining proficiency(Required) Gait Training/ Retraining frequency(Required) Application of Prosthetic Devices *
Application of Prosthetic Devices proficiency(Required) Application of Prosthetic Devices frequency(Required) Application of Orthotic Devices *
Application of Orthotic Devices proficiency(Required) Application of Orthotic Devices frequency(Required)
Wound/ Skin - Care of patients with
Proficiency Rating
Frequency Rating
Pressure Sores *
Pressure Sores proficiency(Required) Pressure Sores frequency(Required) Leg Ulcers *
Leg Ulcers proficiency(Required) Leg Ulcers frequency(Required) Burns *
Burns proficiency(Required) Burns frequency(Required)
Wound/Skin General
Proficiency Rating
Frequency Rating
Acute Dressing Changes *
Acute Dressing Changes proficiency(Required) Acute Dressing Changes frequency(Required) Wound Care *
Wound Care proficiency(Required) Wound Care frequency(Required) Irrigations *
Irrigations proficiency(Required) Irrigations frequency(Required) Identifying Common Skin Problems *
Identifying Common Skin Problems proficiency(Required) Identifying Common Skin Problems frequency(Required) Recognizing Normal Skin Changes *
Recognizing Normal Skin Changes proficiency(Required) Recognizing Normal Skin Changes frequency(Required) Use of Special Pressure Relief Devices *
Use of Special Pressure Relief Devices proficiency(Required) Use of Special Pressure Relief Devices frequency(Required) Pressure Relief Mattress/Seat Cushion *
Pressure Relief Mattress/Seat Cushion proficiency(Required) Pressure Relief Mattress/Seat Cushion frequency(Required)
Additional Skills - Care of patients with
Proficiency Rating
Frequency Rating
Hemovacs *
Hemovacs proficiency(Required) Hemovacs frequency(Required) Jackson-Pratt Tubes *
Jackson-Pratt Tubes proficiency(Required) Jackson-Pratt Tubes frequency(Required) Penrose Drains *
Penrose Drains proficiency(Required) Penrose Drains frequency(Required) T-Tubes *
T-Tubes proficiency(Required) T-Tubes frequency(Required) Wound Vac *
Wound Vac proficiency(Required) Wound Vac frequency(Required) Certify your information(Required) I certify that I have provided true and accurate information about my skills and experience to the best of my ability
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