Neonatal Intensive Care

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Name*

First Last

Phone*

Email*

Age Specific Care

Proficiency Rating

Frequency Rating

Lithotripsy *

Neonate < 23 Weeks proficiency*

Neonate < 23 Weeks frequency*

Lithotripsy *

Neonate 23 - 28 Weeks proficiency*

Neonate 23 - 28 Weeks frequency*

Lithotripsy *

Neonate 29 - 32 Weeks proficiency*

Neonate 29 - 32 Weeks frequency*

Lithotripsy *

Neonate > 32 Weeks proficiency*

Neonate > 32 Weeks frequency*

Lithotripsy *

Full Term Newborn proficiency*

Full Term Newborn frequency*

Neurological

Proficiency Rating

Frequency Rating

Assessment Of Neurological Status *

Assessment Of Neurological Status proficiency*

Assessment Of Neurological Status frequency*

Intracranial Pressure Monitoring *

Intracranial Pressure Monitoring proficiency*

Intracranial Pressure Monitoring frequency*

Neurological - Care of Neonate with:

Proficiency Rating

Frequency Rating

Spina Bifida *

Spina Bifida proficiency*

Spina Bifida frequency*

Myelomeningocele *

Myelomeningocele proficiency*

Myelomeningocele frequency*

Brain Death / Organ Procurement *

Brain Death / Organ Procurement proficiency*

Brain Death / Organ Procurement frequency*

Externalized VP Shunt / Reservoirs *

Externalized VP Shunt / Reservoirs proficiency*

Externalized VP Shunt / Reservoirs frequency*

Intraventricular Hemorrhage *

Intraventricular Hemorrhage proficiency*

Intraventricular Hemorrhage frequency*

Increased Intracranial Pressure *

Increased Intracranial Pressure proficiency*

Increased Intracranial Pressure frequency*

Meningitis *

Meningitis proficiency*

Meningitis frequency*

Seizures *

Seizures proficiency*

Seizures frequency*

Anticonvulsant Medications *

Anticonvulsant Medications proficiency*

Anticonvulsant Medicationsfrequency*

Cardiovascular

Proficiency Rating

Frequency Rating

Assessment / Auscultation (rate, rhythm, volume) *

Assessment / Auscultation (rate, rhythm, volume) proficiency*

Assessment / Auscultation (rate, rhythm, volume) frequency*

Blood Pressure / Invasive (arterial line) *

Blood Pressure / Invasive (arterial line) proficiency*

Blood Pressure / Invasive (arterial line) frequency*

Blood Pressure / Non - invasive *

Blood Pressure / Non - invasive proficiency*

Blood Pressure / Non - invasive frequency*

Heart Sounds / Murmurs *

Heart Sounds / Murmurs proficiency*

Heart Sounds / Murmurs frequency*

Perfusion *

Perfusion proficiency*

Perfusion frequency*

Pulses *

Pulses proficiency*

Pulses frequency*

EKG Interpretation / Rhythm Recognition *

EKG Interpretation / Rhythm Recognition proficiency*

EKG Interpretation / Rhythm Recognition frequency*

Defibrillation / Cardioversion *

Defibrillation / Cardioversion proficiency*

Defibrillation / Cardioversion frequency*

Invasion Hemodynamic Monitoring *

Invasion Hemodynamic Monitoring proficiency*

Invasion Hemodynamic Monitoring frequency*

Central Venous Pressure *

Central Venous Pressure proficiency*

Central Venous Pressure frequency*

Cardiovascular - Care of Neonate with:

Proficiency Rating

Frequency Rating

Cardiac Arrest *

Cardiac Arrest proficiency*

Cardiac Arrest frequency*

Cardiac Transplant *

Cardiac Transplant proficiency*

Cardiac Transplant frequency*

Cardiomyopathy *

Cardiomyopathy proficiency*

Cardiomyopathy frequency*

Congenital Heart Disease / Defects *

Congenital Heart Disease / Defects proficiency*

Congenital Heart Disease / Defects frequency*

Hemodynamic Instability *

Hemodynamic Instability proficiency*

Hemodynamic Instability frequency*

Cardiogenic / Hypovolemic Shock *

Cardiogenic / Hypovolemic Shock proficiency*

Cardiogenic / Hypovolemic Shock frequency*

Post Cardiac Surgery *

Post Cardiac Surgery proficiency*

Post Cardiac Surgery frequency*

Post Cardiac Cath *

Post Cardiac Cath proficiency*

Post Cardiac Cath frequency*

Hyper / Hypotension *

Hyper / Hypotension proficiency*

Hyper / Hypotension frequency*

KNOWLEDGE AND USE OF:

Vasopressin *

Vasopressin proficiency*

Vasopressin frequency*

Digoxin *

Digoxin proficiency*

Digoxin frequency*

Dobutamine *

Dobutamine proficiency*

Dobutamine frequency*

Dopamine *

Dopamine proficiency*

Dopamine frequency*

Epinephrine *

Epinephrine proficiency*

Epinephrine frequency*

Nipride *

Nipride proficiency*

Nipride frequency*

Sodium Bicarbonate *

Sodium Bicarbonate proficiency*

Sodium Bicarbonate frequency*

Respiratory

Proficiency Rating

Frequency Rating

Assessment of Breath Sounds *

Assessment of Breath Sounds proficiency*

Assessment of Breath Sounds frequency*

Rate and Work of Breathing *

Rate and Work of Breathing proficiency*

Rate and Work of Breathing frequency*

Interpretation of ABGs *

Interpretation of ABGs proficiency*

Interpretation of ABGs frequency*

Assist with Chest Tube Insertion *

Assist with Chest Tube Insertion proficiency*

Assist with Chest Tube Insertion frequency*

Assist with Chest Tube Removal *

Assist with Chest Tube Removal proficiency*

Assist with Chest Tube Removal frequency*

ECMO (Extracorporeal Membrane Oxygenation) *

ECMO (Extracorporeal Membrane Oxygenation) proficiency*

ECMO (Extracorporeal Membrane Oxygenation) frequency*

Thoracentesis *

Thoracentesis proficiency*

Thoracentesis frequency*

Use of Artificial Surfactant *

Use of Artificial Surfactant proficiency*

Use of Artificial Surfactant frequency*

Airway Management:

Proficiency Rating

Frequency Rating

Assist with Intubation *

Assist with Intubation proficiency*

Assist with Intubation frequency*

Bulb Syringe *

Bulb Syringe proficiency*

Bulb Syringe frequency*

Endotracheal Tube Suctioning *

Endotracheal Tube Suctioning proficiency*

Endotracheal Tube Suctioning frequency*

In - Line Suction *

In - Line Suction proficiency*

In - Line Suction frequency*

Open ET Catheter Suction *

Open ET Catheter Suction proficiency*

Open ET Catheter Suction frequency*

Extubation *

Extubation proficiency*

Extubation frequency*

Nasal / Oral Airway / Suctioning *

Nasal / Oral Airway / Suctioning proficiency*

Nasal / Oral Airway / Suctioning frequency*

Tracheostomy / Suctioning *

Tracheostomy / Suctioning proficiency*

Tracheostomy / Suctioning frequency*

Apnea Monitor *

Apnea Monitor proficiency*

Apnea Monitor frequency*

Respiratory Insufficiency *

Respiratory Insufficiency proficiency*

Respiratory Insufficiency frequency*

Respiratory Arrest *

Respiratory Arrest proficiency*

Respiratory Arrest frequency*

O2 Therapy Delivery Systems:

Proficiency Rating

Frequency Rating

Bag and Mask *

Bag and Mask proficiency*

Bag and Mask frequency*

Nasal Cannula *

Nasal Cannula proficiency*

Nasal Cannula frequency*

Nebulizer *

Nebulizer proficiency*

Nebulizer frequency*

Oxyhood / Tent *

Oxyhood / Tent proficiency*

Oxyhood / Tent frequency*

Trach Collar *

Trach Collar proficiency*

Trach Collar frequency*

Obtaining Labs:

Proficiency Rating

Frequency Rating

Arterial *

Arterial proficiency*

Arterial frequency*

Heelstick *

Heelstick proficiency*

Heelstick frequency*

Peripheral *

Peripheral proficiency*

Peripheral frequency*

Umbilical Line *

Umbilical Line proficiency*

Umbilical Line frequency*

Use of Ventilators:

Proficiency Rating

Frequency Rating

CPAP / PEEP *

CPAP / PEEP proficiency*

CPAP / PEEP frequency*

High Frequency Jet Ventilator *

High Frequency Jet Ventilator proficiency*

High Frequency Jet Ventilator frequency*

Home Ventilator *

Home Ventilator proficiency*

Home Ventilator frequency*

IMV *

IMV proficiency*

IMV frequency*

Oscillating *

Oscillating proficiency*

Oscillating frequency*

Pressure Ventilator *

Pressure Ventilator proficiency*

Pressure Ventilator frequency*

Volume Ventilator *

Volume Ventilator proficiency*

Volume Ventilator frequency*

CO2 Monitoring *

CO2 Monitoring proficiency*

CO2 Monitoring frequency*

Weaning *

Weaning proficiency*

Weaning frequency*

Respiratory - Care of Neonate with:

Proficiency Rating

Frequency Rating

Apnea *

Apnea proficiency*

Apnea frequency*

Meconium Aspiration *

Meconium Aspiration proficiency*

Meconium Aspiration frequency*

Persistent Pulmonary Hypertension (PPHN) *

Persistent Pulmonary Hypertension (PPHN) proficiency*

Persistent Pulmonary Hypertension (PPHN) frequency*

Bronchopulmonary Dysplasia (BPD) *

Bronchopulmonary Dysplasia (BPD) proficiency*

Bronchopulmonary Dysplasia (BPD) frequency*

Diaphragmatic Hernia *

Diaphragmatic Hernia proficiency*

Diaphragmatic Hernia frequency*

Fresh Tracheostomy *

Fresh Tracheostomy proficiency*

Fresh Tracheostomy frequency*

Pneumothorax *

Pneumothorax proficiency*

Pneumothorax frequency*

Respiratory Distress Syndrome (RDS) *

Respiratory Distress Syndrome (RDS) proficiency*

Respiratory Distress Syndrome (RDS) frequency*

Respiratory Failure *

Respiratory Failure proficiency*

Respiratory Failure frequency*

KNOWLEDGE AND USE OF:

Aldactazide *

Aldactazide proficiency*

Aldactazide frequency*

Lasix *

Lasix proficiency*

Lasix frequency*

Caffeine *

Caffeine proficiency*

Caffeine frequency*

Prostaglandin *

Prostaglandin proficiency*

Prostaglandin frequency*

Bronchodilators *

Bronchodilators proficiency*

Bronchodilators frequency*

Steroids *

Steroids proficiency*

Steroids frequency*

Gastrointestinal

Proficiency Rating

Frequency Rating

Abdominal Girth *

Abdominal Girth proficiency*

Abdominal Girth frequency*

Bowel Sounds *

Bowel Sounds proficiency*

Bowel Sounds frequency*

Palate *

Palate proficiency*

Palate frequency*

Suck / Swallow *

Suck / Swallow proficiency*

Suck / Swallow frequency*

Care of Gastrostomy Tube *

Care of Gastrostomy Tube proficiency*

Care of Gastrostomy Tube frequency*

Test for Occult Blood *

Test for Occult Blood proficiency*

Test for Occult Blood frequency*

Feedings:

Proficiency Rating

Frequency Rating

Assist with Breast Feeding *

Assist with Breast Feeding proficiency*

Assist with Breast Feeding frequency*

Bottle *

Bottle proficiency*

Bottle frequency*

Breast Milk Handling / Storage *

Breast Milk Handling / Storage proficiency*

Breast Milk Handling / Storage frequency*

Gavage *

Gavage proficiency*

Gavage frequency*

Placement of Intestinal Tubes:

Proficiency Rating

Frequency Rating

Hospital Grade Electronic Breast Pump *

Hospital Grade Electronic Breast Pump proficiency*

Hospital Grade Electronic Breast Pump frequency*

Jejunal / Gastro *

Jejunal / Gastro proficiency*

Jejunal / Gastro frequency*

Nasogastric / Orogastric *

Nasogastric / Orogastric proficiency*

Nasogastric / Orogastric frequency*

Gastrointestinal - Care of Neonate with:

Proficiency Rating

Frequency Rating

Cleft lip / Palate *

Cleft lip / Palate proficiency*

Cleft lip / Palate frequency*

GI Bleed *

GI Bleed proficiency*

GI Bleed frequency*

Ostomy *

Ostomy proficiency*

Ostomy frequency*

Post Abdominal Surgery *

Post Abdominal Surgery proficiency*

Post Abdominal Surgery frequency*

Inguinal hernia *

Inguinal hernia proficiency*

Inguinal hernia frequency*

Necrotizing Enterocolitis *

Necrotizing Enterocolitis proficiency*

Necrotizing Enterocolitis frequency*

Gastroschesis / Omphalocele *

Gastroschesis / Omphalocele proficiency*

Gastroschesis / Omphalocele frequency*

Reflux *

Reflux proficiency*

Reflux frequency*

Tracheoesophageal Fistula (TEF) *

Tracheoesophageal Fistula (TEF) proficiency*

Tracheoesophageal Fistula (TEF) frequency*

Renal / GU / Metabolic / Endocrine General Skills

Proficiency Rating

Frequency Rating

Fluid & Electrolyte Balance *

Fluid & Electrolyte Balance proficiency*

Fluid & Electrolyte Balance frequency*

Calculating Output *

Calculating Output proficiency*

Calculating Output frequency*

Knowledge / Interpretation of Lab results / Chemistry *

Knowledge / Interpretation of Lab results / Chemistry proficiency*

Knowledge / Interpretation of Lab results / Chemistry frequency*

Bilirubin *

Bilirubin proficiency*

Bilirubin frequency*

Glucose *

Glucose proficiency*

Glucose frequency*

Labstix *

Labstix proficiency*

Labstix frequency*

Occult Blood *

Occult Blood proficiency*

Occult Blood frequency*

pH *

pH proficiency*

pH frequency*

Specific Gravity *

Specific Gravity proficiency*

Specific Gravity frequency*

Collection of Urine Specimens:

Proficiency Rating

Frequency Rating

Assist with Suprapubic Tab *

Assist with Suprapubic Tab proficiency*

Assist with Suprapubic Tab frequency*

Catheter:

Proficiency Rating

Frequency Rating

Diaper / Bag *

Diaper / Bag proficiency*

Diaper / Bag frequency*

Phototherapy for Jaundice *

Phototherapy for Jaundice proficiency*

Phototherapy for Jaundice frequency*

Post Circumcision Care *

Post Circumcision Care proficiency*

Post Circumcision Care frequency*

Renal / GU / Metabolic / Endocrine - Care of Neonate with:

Proficiency Rating

Frequency Rating

Acute Renal Failure *

Acute Renal Failure proficiency*

Acute Renal Failure frequency*

DIC (disseminated Intravascular Coagulation) *

DIC (disseminated Intravascular Coagulation) proficiency*

DIC (disseminated Intravascular Coagulation) frequency*

Disorders of Internal / External Organs *

Disorders of Internal / External Organs proficiency*

Disorders of Internal / External Organs frequency*

Drug Addiction / Withdrawal *

Drug Addiction / Withdrawal proficiency*

Drug Addiction / Withdrawal frequency*

Hyper / Hypokalemia *

Hyper / Hypokalemia proficiency*

Hyper / Hypokalemia frequency*

Hyper / Hyponatremia *

Hyper / Hyponatremia proficiency*

Hyper / Hyponatremia frequency*

Infant of Diabetic Mother - Monitor for Hyper / Hypoglycemia *

Infant of Diabetic Mother - Monitor for Hyper / Hypoglycemia proficiency*

Infant of Diabetic Mother - Monitor for Hyper / Hypoglycemia frequency*

Malformations of the GU Tract, Kidney *

Malformations of the GU Tract, Kidney proficiency*

Malformations of the GU Tract, Kidney frequency*

Peritoneal Dialysis *

Peritoneal Dialysis proficiency*

Peritoneal Dialysis frequency*

Infectious Diseases

Proficiency Rating

Frequency Rating

Assist with Lumbar Puncture *

Assist with Lumbar Puncture proficiency*

Assist with Lumbar Puncture frequency*

Collect Culture Specimens *

Collect Culture Specimens proficiency*

Collect Culture Specimens frequency*

Isolation Techniques *

Isolation Techniques proficiency*

Isolation Techniques frequency*

Standard Precautions *

Standard Precautions proficiency*

Standard Precautions frequency*

Knowledge of Lab Results:

Proficiency Rating

Frequency Rating

CBC / Differential *

CBC / Differential proficiency*

CBC / Differential frequency*

Culture Reports *

Culture Reports proficiency*

Culture Reports frequency*

Maternal Lab Results *

Maternal Lab Results proficiency*

Maternal Lab Results frequency*

Infectious Disease - Care of Neonate with:

Proficiency Rating

Frequency Rating

Hepatitis Surface Antigen + Mother *

Hepatitis Surface Antigen + Mother proficiency*

Hepatitis Surface Antigen + Mother frequency*

HIV Positive Mother *

HIV Positive Mother proficiency*

HIV Positive Mother frequency*

Neonatal Sepsis *

Neonatal Sepsis proficiency*

Neonatal Sepsis frequency*

KNOWLEDGE AND USE OF:

Antibiotics *

Antibiotics proficiency*

Antibiotics frequency*

HBIG *

HBIG proficiency*

HBIG frequency*

HBV *

HBV proficiency*

HBV frequency*

HIB *

HIB proficiency*

HIB frequency*

RespiGam / Synagis Prophylaxis *

RespiGam / Synagis Prophylaxis proficiency*

RespiGam / Synagis Prophylaxis frequency*

Medication Skills / Knowledge and Use of

Proficiency Rating

Frequency Rating

Calculation of Dosage *

Calculation of Dosage proficiency*

Calculation of Dosage frequency*

Prep and Administration of Emergency Meds *

Prep and Administration of Emergency Meds proficiency*

Prep and Administration of Emergency Meds frequency*

Emergency Drug Action & Reaction *

Emergency Drug Action & Reaction proficiency*

Emergency Drug Action & Reaction frequency*

Eye Prophylaxis – Vitamin K *

Eye Prophylaxis – Vitamin K proficiency*

Eye Prophylaxis – Vitamin K frequency*

Neonatal Drug Action & Reactions *

Neonatal Drug Action & Reactions proficiency*

Neonatal Drug Action & Reactions frequency*

Computerized / Automated Medication Administration System *

Computerized / Automated Medication Administration System proficiency*

Computerized / Automated Medication Administration System frequency*

List Types:

Computerized / Automated Medication Administration System *

Computerized / Automated Medication Administration System proficiency*

Computerized / Automated Medication Administration System frequency*

List Types:

Pain Management

Proficiency Rating

Frequency Rating

Assessment Of Pain Level Using Age Appropriate Scales *

Assessment Of Pain Level Using Age Appropriate Scales proficiency*

Assessment Of Pain Level Using Age Appropriate Scales frequency*

Care of Neonate with Sedation *

Care of Neonate with Sedation proficiency*

Care of Neonate with Sedation frequency*

Use of Sedation Reversal Agents *

Use of Sedation Reversal Agents proficiency*

Use of Sedation Reversal Agents frequency*

Administration of Blood / Blood Products

Proficiency Rating

Frequency Rating

Cryoprecipitate *

Cryoprecipitate proficiency*

Cryoprecipitate frequency*

Packed Red Blood Cells *

Packed Red Blood Cells proficiency*

Packed Red Blood Cells frequency*

Plasma / Albumin *

Plasma / Albumin proficiency*

Plasma / Albumin frequency*

Whole Blood *

Whole Blood proficiency*

Whole Blood frequency*

Drawing Blood from Central Line *

Drawing Blood from Central Line proficiency*

Drawing Blood from Central Line frequency*

Drawing Venous Blood *

Drawing Venous Blood proficiency*

Drawing Venous Blood frequency*

Delivery Systems:

Proficiency Rating

Frequency Rating

IV Pump *

IV Pump proficiency*

IV Pump frequency*

Syringe Pump *

Syringe Pump proficiency*

Syringe Pump frequency*

Hyperalimentation / TPN / PPN *

Hyperalimentation / TPN / PPN proficiency*

Hyperalimentation / TPN / PPN frequency*

Intralipid *

Intralipid proficiency*

Intralipid frequency*

Managing IV Therapy:

Proficiency Rating

Frequency Rating

Insertion *

Insertion proficiency*

Insertion frequency*

Discontinuation *

Discontinuation proficiency*

Discontinuation frequency*

Dressing & Tubing Change *

Dressing & Tubing Change proficiency*

Dressing & Tubing Change frequency*

Dressing & Tubing Change *

Dressing & Tubing Change proficiency*

Dressing & Tubing Change frequency*

Site & Patency Assessment *

Site & Patency Assessment proficiency*

Site & Patency Assessment frequency*

IV Therapy / Phlebotomy - Care of The Neonate With:

Proficiency Rating

Frequency Rating

Central Line / Catheter / Dressing *

Central Line / Catheter / Dressing proficiency*

Central Line / Catheter / Dressing frequency*

Broviac *

Broviac proficiency*

Broviac frequency*

Groshong *

Groshong proficiency*

Groshong frequency*

Hickman *

Hickman proficiency*

Hickman frequency*

Port - A - Cath *

Port - A - Cath proficiency*

Port - A - Cath frequency*

Quinton *

Quinton proficiency*

Quinton frequency*

Percutaneous Arterial Line *

Percutaneous Arterial Line proficiency*

Percutaneous Arterial Line frequency*

PICC (peripherally inserted central catheter) *

PICC (peripherally inserted central catheter) proficiency*

PICC (peripherally inserted central catheter)frequency*

Umbilical Artery Line *

Umbilical Artery Line proficiency*

Umbilical Artery Line frequency*

Umbilical Venous Line *

Umbilical Venous Line proficiency*

Umbilical Venous Line frequency*

Other / Misc:

Proficiency Rating

Frequency Rating

Crash Carts *

Crash Carts proficiency*

Crash Carts frequency*

Defibrillators *

Defibrillators proficiency*

Defibrillators frequency*

Computerized Charting System *

Computerized Charting System proficiency*

Computerized Charting System frequency*

List Types:

Apgar Scoring *

Apgar Scoring proficiency*

Apgar Scoring frequency*

Eye Exam (r/o retinopathy) *

Eye Exam (r/o retinopathy) proficiency*

Eye Exam (r/o retinopathy) frequency*

Cord Care *

Cord Care proficiency*

Cord Care frequency*

Neonatal Skin Care *

Neonatal Skin Care proficiency*

Neonatal Skin Care frequency*

Positioning Devices *

Positioning Devices proficiency*

Positioning Devices frequency*

Preparation for Transport / Transfer *

Preparation for Transport / Transfer proficiency*

Preparation for Transport / Transfer frequency*

Gestational Age:

Proficiency Rating

Frequency Rating

Car Seat Safety *

Car Seat Safety proficiency*

Car Seat Safety frequency*

Ballard *

Ballard proficiency*

Ballard frequency*

Dubowitz *

Dubowitz proficiency*

Dubowitz frequency*

Other (Specify):

Maternal History *

Maternal History proficiency*

Maternal History frequency*

Screen for Hearing Loss *

Screen for Hearing Loss proficiency*

Screen for Hearing Loss frequency*

Equipment & Procedures *

Equipment & Procedures proficiency*

Equipment & Procedures frequency*

Bereavement / Postmortem Care *

Bereavement / Postmortem Care proficiency*

Bereavement / Postmortem Care frequency*

Consents *

Consents proficiency*

Consents frequency*

Immunization *

Immunization proficiency*

Immunization frequency*

Procedural *

Procedural proficiency*

Procedural frequency*

Treatment *

Treatment proficiency*

Treatment frequency*

Family Teaching / Education *

Family Teaching / Education proficiency*

Family Teaching / Education frequency*

Care Planning *

Care Planning proficiency*

Care Planning frequency*

Thermoregulation:

Proficiency Rating

Frequency Rating

Isolette with Humidity *

Isolette with Humidity proficiency*

Isolette with Humidity frequency*

Radiant Warmer *

Radiant Warmer proficiency*

Radiant Warmer frequency*

Temperature (auxillary, rectal, skin) *

Temperature (auxillary, rectal, skin) proficiency*

Temperature (auxillary, rectal, skin) frequency*

Weaning to Open Crib / Bassinet *

Weaning to Open Crib / Bassinet proficiency*

Weaning to Open Crib / Bassinet frequency*

Weights:

Proficiency Rating

Frequency Rating

Bed Scale *

Bed Scale proficiency*

Bed Scale frequency*

Scale *

Scale proficiency*

Scale frequency*

List Any Additional Training:

List Any Additional Skills:

List Any Additional Equipment:

Do you have Experience with ventilators?*

Yes

List Types:

Do you have Experience with cardiac monitors?*

Yes

List Types:

Do you have Experience with NRP Current?*

Yes

Do you have Experience with STABLE Current?*

Yes

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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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Date*

Skills/Competences

Proficiency

Frequency

NEONATAL INTENSIVE CARE

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