Ultrasound Tech

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Name*

First Last

Phone*

Email*

Age Specific Care

Proficiency Rating

Frequency Rating

Newborn/Neonate (birth - 30 days) *

Newborn/Neonate (birth - 30 days) proficiency*

Newborn/Neonate (birth - 30 days) frequency*

Infant (30 days - 1 year) *

Infant (30 days - 1 year) proficiency*

Infant (30 days - 1 year) frequency*

Toddler (1 - 3 years) *

Toddler (1 - 3 years) proficiency*

Toddler (1 - 3 years) frequency*

Preschooler (3 - 5 years) *

Preschooler (3 - 5 years) proficiency*

Preschooler (3 - 5 years) frequency*

School Age Child (5 - 12 years) *

School Age Child (5 - 12 years) proficiency*

School Age Child (5 - 12 years) frequency*

Adolescents (12 - 18 years) *

Adolescents (12 - 18 years) proficiency*

Adolescents (12 - 18 years) frequency*

Young Adults (18 - 39 years) *

Young Adults (18 - 39 years) proficiency*

Young Adults (18 - 39 years) frequency*

Middle Adults (39 - 64 years) *

Middle Adults (39 - 64 years) proficiency*

Middle Adults (39 - 64 years) frequency*

Older Adults (64+ years) *

Older Adults (64+ years) proficiency*

Older Adults (64+ years) frequency*

Elderly Adults (over 79+ years) *

Elderly Adults (over 79+ years) proficiency*

Elderly Adults (over 79+ years) frequency*

Work Settings

Proficiency Rating

Frequency Rating

Adult *

Adult proficiency*

Adult frequency*

Pediatrics *

Pediatrics proficiency*

Pediatrics frequency*

Neonatal *

Neonatal proficiency*

Neonatal frequency*

Obstetrics *

Obstetrics proficiency*

Obstetrics frequency*

High Risk OB *

High Risk OB proficiency*

High Risk OB frequency*

Maternal/Fetal Medicine *

Maternal/Fetal Medicine proficiency*

Maternal/Fetal Medicine frequency*

General Ultrasound

Proficiency Rating

Frequency Rating

Abdominal - Limited/Complete *

Abdominal - Limited/Complete proficiency*

Abdominal - Limited/Complete frequency*

Aorta *

Aorta proficiency*

Aorta frequency*

Appendix *

Appendix proficiency*

Appendix frequency*

Biliary Tract *

Biliary Tract proficiency*

Biliary Tract frequency*

Gall Bladder *

Gall Bladder proficiency*

Gall Bladder frequency*

Liver *

Liver proficiency*

Liver frequency*

Lung Biopsy *

Lung Biopsy proficiency*

Lung Biopsy frequency*

Pancreas *

Pancreas proficiency*

Pancreas frequency*

Paracentesis *

Paracentesis proficiency*

Paracentesis frequency*

Renal/Cyst Aspiration *

Renal/Cyst Aspiration proficiency*

Renal/Cyst Aspiration frequency*

Spleen *

Spleen proficiency*

Spleen frequency*

Pelvic Male *

Pelvic Male proficiency*

Pelvic Male frequency*

Intra-operative *

Intra-operative proficiency*

Intra-operative frequency*

Thoracentesis *

Thoracentesis proficiency*

Thoracentesis frequency*

Principles and Instrumentation

Proficiency Rating

Frequency Rating

Performing independent operation of and diagnostic examination using various machines *

Performing independent operation of and diagnostic examination using various machines proficiency*

Performing independent operation of and diagnostic examination using various machines frequency*

2-D *

2-D proficiency*

2-D frequency*

Color Flow Imaging *

Color Flow Imaging proficiency*

Color Flow Imaging frequency*

Gray-scale Imaging *

Gray-scale Imaging proficiency*

Gray-scale Imaging frequency*

Harmonic Imaging *

Harmonic Imaging proficiency*

Harmonic Imaging frequency*

Linear Array Transducer *

Linear Array Transducer proficiency*

Linear Array Transducer frequency*

Phased Array Transducer *

Phased Array Transducer proficiency*

Phased Array Transducer frequency*

Power Doppler *

Power Doppler proficiency*

Power Doppler frequency*

Pulsed Waved Doppler *

Pulsed Waved Doppler proficiency*

Pulsed Waved Doppler frequency*

Real Time *

Real Time proficiency*

Real Time frequency*

Use Cognitive Sonographic Skills *

Use Cognitive Sonographic Skills proficiency*

Use Cognitive Sonographic Skills frequency*

Identify, Record, and Adapt Procedures *

Identify, Record, and Adapt Procedures proficiency*

Identify, Record, and Adapt Procedures frequency*

Assess Artifacts of Color Doppler Imaging *

Assess Artifacts of Color Doppler Imaging proficiency*

Assess Artifacts of Color Doppler Imaging frequency*

Assess Artifacts of Gray-Scale Imaging *

Assess Artifacts of Gray-Scale Imaging proficiency*

Assess Artifacts of Gray-Scale Imaging frequency*

Assess Artifacts of Spectral Doppler Imaging *

Assess Artifacts of Spectral Doppler Imaging proficiency*

Assess Artifacts of Spectral Doppler Imaging frequency*

Assist with diagnostic procedures that involve blood, body fluids, and tissues, including needle-biopsy procedures *

Assist with diagnostic procedures that involve blood, body fluids, and tissues, including needle-biopsy procedures proficiency*

Assist with diagnostic procedures that involve blood, body fluids, and tissues, including needle-biopsy procedures frequency*

Correlate Ultrasound Findings with Other Imaging Modalities *

Correlate Ultrasound Findings with Other Imaging Modalities proficiency*

Correlate Ultrasound Findings with Other Imaging Modalities frequency*

Evaluate sonograms to acquire appropriate diagnostic information, make adjustments to output power, presets, and resolution to optimize image quality *

Evaluate sonograms to acquire appropriate diagnostic information, make adjustments to output power, presets, and resolution to optimize image quality proficiency*

Evaluate sonograms to acquire appropriate diagnostic information, make adjustments to output power, presets, and resolution to optimize image quality frequency*

Integrate all Data to Assist with Proper Diagnosis *

Integrate all Data to Assist with Proper Diagnosis proficiency*

Integrate all Data to Assist with Proper Diagnosis frequency*

Perform Diagnostic Image assessment *

Perform Diagnostic Image assessment proficiency*

Perform Diagnostic Image assessment frequency*

Perform all requested sonographic examinations as ordered by the physician *

Perform all requested sonographic examinations as ordered by the physician proficiency*

Perform all requested sonographic examinations as ordered by the physician frequency*

Accurately differentiate between normal and pathological findings *

Accurately differentiate between normal and pathological findings proficiency*

Accurately differentiate between normal and pathological findings frequency*

Thoracic Spine *

Thoracic Spine proficiency*

Thoracic Spine frequency*

Lumbar Spine *

Lumbar Spine proficiency*

Lumbar Spine frequency*

Hemodynamic and Doppler Principles

Proficiency Rating

Frequency Rating

Assess Perfusion and Functions of Various Areas *

Assess Perfusion and Functions of Various Areas proficiency*

Assess Perfusion and Functions of Various Areas frequency*

Assess Perfusion and Functions of Various Areas *

Assess Perfusion and Functions of Various Areas proficiency*

Assess Perfusion and Functions of Various Areas frequency*

Evaluate Scrotum and Contents (i.e., Testes, Epididymis) for Function and/or Perfusion *

Evaluate Scrotum and Contents (i.e., Testes, Epididymis) for Function and/or Perfusion proficiency*

Evaluate Scrotum and Contents (i.e., Testes, Epididymis) for Function and/or Perfusion frequency*

Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) *

Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) proficiency*

Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) frequency*

Liver *

Liver proficiency*

Liver frequency*

Retroperitoneum (e.g., Great Vessels and Branches) *

Retroperitoneum (e.g., Great Vessels and Branches) proficiency*

Retroperitoneum (e.g., Great Vessels and Branches) frequency*

Spleen for Vascular Abnormalities (e.g., Infarction) *

Spleen for Vascular Abnormalities (e.g., Infarction) proficiency*

Spleen for Vascular Abnormalities (e.g., Infarction) frequency*

Urinary System (i.e., Kidneys, Ureters, Bladder) for Function and/or Perfusion *

Urinary System (i.e., Kidneys, Ureters, Bladder) for Function and/or Perfusion proficiency*

Urinary System (i.e., Kidneys, Ureters, Bladder) for Function and/or Perfusion frequency*

Vascularity of the Neck Structures for Abnormalities *

Vascularity of the Neck Structures for Abnormalities proficiency*

Vascularity of the Neck Structures for Abnormalities frequency*

Ability to Make Adjustments in Doppler Instrumentation *

Ability to Make Adjustments in Doppler Instrumentation proficiency*

Ability to Make Adjustments in Doppler Instrumentation frequency*

Adjust Color Gain *

Adjust Color Gain proficiency*

Adjust Color Gain frequency*

Color Angle to Flow *

Color Angle to Flow proficiency*

Color Angle to Flow frequency*

Color Scale *

Color Scale proficiency*

Color Scale frequency*

Modifying Exam Based Upon Artifacts *

Modifying Exam Based Upon Artifacts proficiency*

Modifying Exam Based Upon Artifacts frequency*

Obtain Measurements of Blood Flow Velocities *

Obtain Measurements of Blood Flow Velocities proficiency*

Obtain Measurements of Blood Flow Velocities frequency*

Abdomen

Proficiency Rating

Frequency Rating

Normal Anatomy of Abdomen *

Normal Anatomy of Abdomen proficiency*

Normal Anatomy of Abdomen frequency*

Adrenal Glands for Masses and/or Trauma *

Adrenal Glands for Masses and/or Trauma proficiency*

Adrenal Glands for Masses and/or Trauma frequency*

Anatomic Structures of the Biliary System *

Anatomic Structures of the Biliary System proficiency*

Anatomic Structures of the Biliary System frequency*

Anatomic Structures of the Liver *

Anatomic Structures of the Liver proficiency*

Anatomic Structures of the Liver frequency*

Anatomic Structures of the Pancreas *

Anatomic Structures of the Pancreas proficiency*

Anatomic Structures of the Pancreas frequency*

Anatomic Structures of the Peritoneal Cavity *

Anatomic Structures of the Peritoneal Cavity proficiency*

Anatomic Structures of the Peritoneal Cavity frequency*

Anatomic structures of the Retroperitoneum such as great vessels and branches *

Anatomic structures of the Retroperitoneum such as great vessels and branches proficiency*

Anatomic structures of the Retroperitoneum such as great vessels and branches frequency*

Anatomic Structures of the Spleen *

Anatomic Structures of the Spleen proficiency*

Anatomic Structures of the Spleen frequency*

Anatomic Structures of the Urinary System (i.e., Kidneys, Ureters, Bladder) *

Anatomic Structures of the Urinary System (i.e., Kidneys, Ureters, Bladder) proficiency*

Anatomic Structures of the Urinary System (i.e., Kidneys, Ureters, Bladder) frequency*

Biliary Infection *

Biliary Infection proficiency*

Biliary Infection frequency*

Biliary Masses i.e.: Primary Tumors, Metastatic Disease Biliary Obstruction *

Biliary Masses i.e.: Primary Tumors, Metastatic Disease Biliary Obstruction proficiency*

Biliary Masses i.e.: Primary Tumors, Metastatic Disease Biliary Obstruction frequency*

Diffuse Hepatocellular Disease i.e.: Hepatitis, Fatty Infiltration, Cirrhosis *

Diffuse Hepatocellular Disease i.e.: Hepatitis, Fatty Infiltration, Cirrhosis proficiency*

Diffuse Hepatocellular Disease i.e.: Hepatitis, Fatty Infiltration, Cirrhosis frequency*

Diffuse Splenic Disease i.e.: Splenomegaly, Parenchymal Changes *

Diffuse Splenic Disease i.e.: Splenomegaly, Parenchymal Changes proficiency*

Diffuse Splenic Disease i.e.: Splenomegaly, Parenchymal Changes frequency*

Gastrointestinal (GI) System for Herniation *

Gastrointestinal (GI) System for Herniation proficiency*

Gastrointestinal (GI) System for Herniation frequency*

Gastrointestinal (GI) System for Inflammation Such as Appendicitis, Colitis *

Gastrointestinal (GI) System for Inflammation Such as Appendicitis, Colitis proficiency*

Gastrointestinal (GI) System for Inflammation Such as Appendicitis, Colitis frequency*

Gastrointestinal (GI) System for Obstruction Such as Pyloric Stenosis, Intussusception *

Gastrointestinal (GI) System for Obstruction Such as Pyloric Stenosis, Intussusception proficiency*

Gastrointestinal (GI) System for Obstruction Such as Pyloric Stenosis, Intussusception frequency*

Hepatic Masses i.e.: Neoplasm, Abscess, Cyst *

Hepatic Masses i.e.: Neoplasm, Abscess, Cyst proficiency*

Hepatic Masses i.e.: Neoplasm, Abscess, Cyst frequency*

Liver for vascular abnormalities such as arteriovenous fistula, portal vein thrombosis, collateralization and transjugular intrahepatic portovenous shunt (TIPS) *

Liver for vascular abnormalities such as arteriovenous fistula, portal vein thrombosis, collateralization and transjugular intrahepatic portovenous shunt (TIPS) proficiency*

Liver for vascular abnormalities such as arteriovenous fistula, portal vein thrombosis, collateralization and transjugular intrahepatic portovenous shunt (TIPS) frequency*

Pancreatic Infection *

Pancreatic Infection proficiency*

Pancreatic Infection frequency*

Pancreatic Masses and Obstruction *

Pancreatic Masses and Obstruction proficiency*

Pancreatic Masses and Obstruction frequency*

Peritoneal Cavity for the Presence of Fluid *

Peritoneal Cavity for the Presence of Fluid proficiency*

Peritoneal Cavity for the Presence of Fluid frequency*

Splenic Masses *

Splenic Masses proficiency*

Splenic Masses frequency*

Urinary System (i.e., Kidneys, Ureters, Bladder) for Parenchymal Disease *

Urinary System (i.e., Kidneys, Ureters, Bladder) for Parenchymal Disease proficiency*

Urinary System (i.e., Kidneys, Ureters, Bladder) for Parenchymal Disease frequency*

Urinary System, Such as Kidneys, Ureters, Bladder, for Masses and Obstruction *

Urinary System, Such as Kidneys, Ureters, Bladder, for Masses and Obstruction proficiency*

Urinary System, Such as Kidneys, Ureters, Bladder, for Masses and Obstruction frequency*

Urinary System, Such as Kidneys, Ureters, Bladder, for Vascular Abnormalities *

Urinary System, Such as Kidneys, Ureters, Bladder, for Vascular Abnormalities proficiency*

Urinary System, Such as Kidneys, Ureters, Bladder, for Vascular Abnormalities frequency*

Vascular

Proficiency Rating

Frequency Rating

Carotids *

Carotids proficiency*

Carotids frequency*

Stroke Protocols (DVT) *

Stroke Protocols (DVT) proficiency*

Stroke Protocols (DVT) frequency*

Arterials (Arms and Legs) *

Arterials (Arms and Legs) proficiency*

Arterials (Arms and Legs) frequency*

Small Parts

Proficiency Rating

Frequency Rating

Anatomic Structures of the Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) *

Anatomic Structures of the Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) proficiency*

Anatomic Structures of the Glands of the Neck (i.e., Thyroid, Parathyroid, Salivary) frequency*

Anatomic Structures of the Other Superficial Structures (e.g., Subcutaneous) *

Anatomic Structures of the Other Superficial Structures (e.g., Subcutaneous) proficiency*

Anatomic Structures of the Other Superficial Structures (e.g., Subcutaneous) frequency*

Breast for Infection or Abscess *

Breast for Infection or Abscess proficiency*

Breast for Infection or Abscess frequency*

Joints for Effusion *

Joints for Effusion proficiency*

Joints for Effusion frequency*

Superficial Structures for Foreign Body *

Superficial Structures for Foreign Body proficiency*

Superficial Structures for Foreign Body frequency*

Superficial Structures for Infection *

Superficial Structures for Infection proficiency*

Superficial Structures for Infection frequency*

Superficial Structures for Masses *

Superficial Structures for Masses proficiency*

Superficial Structures for Masses frequency*

Male Genitorinary

Proficiency Rating

Frequency Rating

Anatomic Structures of the Penis *

Anatomic Structures of the Penis proficiency*

Anatomic Structures of the Penis frequency*

Anatomic Structures of the Prostate *

Anatomic Structures of the Prostate proficiency*

Anatomic Structures of the Prostate frequency*

Anatomic Structures of the Scrotum and Contents *

Anatomic Structures of the Scrotum and Contents, Such as Testes, Epididymis proficiency*

Anatomic Structures of the Scrotum and Contents, Such as Testes, Epididymis frequency*

Prostate for Benign Prostatic Hypertrophy *

Prostate for Benign Prostatic Hypertrophy proficiency*

Prostate for Benign Prostatic Hypertrophy frequency*

Scrotum and Content for Abnormalities Related to Traumatic Events *

Scrotum and Content for Abnormalities Related to Traumatic Events proficiency*

Scrotum and Content for Abnormalities Related to Traumatic Events frequency*

Female Genitorinary

Proficiency Rating

Frequency Rating

Anatomic Structures of the Uterus *

Anatomic Structures of the Uterus proficiency*

Anatomic Structures of the Uterus frequency*

Anatomic Structures of the Ovaries *

Anatomic Structures of the Ovaries proficiency*

Anatomic Structures of the Ovaries frequency*

Anatomic Structures of the Endometrial Canal *

Anatomic Structures of the Endometrial Canal proficiency*

Anatomic Structures of the Endometrial Canal frequency*

Adnexa *

Adnexa proficiency*

Adnexa frequency*

Transvaginal *

Transvaginal proficiency*

Transvaginal frequency*

Ob/Gyn 1st Tri

Proficiency Rating

Frequency Rating

Adnexa *

Adnexaproficiency*

Adnexa frequency*

Amniotic Fluid (Abnormal) *

Amniotic Fluid (Abnormal) proficiency*

Amniotic Fluid (Abnormal) frequency*

Amniotic Fluid (Normal) *

Amniotic Fluid (Normal) proficiency*

Amniotic Fluid (Normal) frequency*

Crown Rump Length 6-14 weeks *

Crown Rump Length 6-14 weeks proficiency*

Crown Rump Length 6-14 weeks frequency*

Fetal Demise *

Fetal Demise proficiency*

Fetal Demise frequency*

Left Ventricular Outflow Tract (LVOT) *

Left Ventricular Outflow Tract (LVOT) proficiency*

Left Ventricular Outflow Tract (LVOT) frequency*

Right Ventricular Outflow Tract (RVOT) *

Right Ventricular Outflow Tract (RVOT) proficiency*

Right Ventricular Outflow Tract (RVOT) frequency*

Multiple Pregnancy *

Multiple Pregnancy proficiency*

Multiple Pregnancy frequency*

Spine if Visualized *

Spine if Visualized proficiency*

Spine if Visualized frequency*

Lower Uterine Segment *

Lower Uterine Segment proficiency*

Lower Uterine Segment frequency*

Nuchal Translucency *

Nuchal Translucency proficiency*

Nuchal Translucency frequency*

Placenta Previa *

Placenta Previa proficiency*

Placenta Previa frequency*

Ob/Gyn 2nd Tri

Proficiency Rating

Frequency Rating

Cervical Shortening *

Cervical Shortening proficiency*

Cervical Shortening frequency*

Insert into Placental and Abdomen *

Insert into Placental and Abdomen proficiency*

Insert into Placental and Abdomen frequency*

3-Vessel Cord/Ratio/Insertion *

3-Vessel Cord/Ratio/Insertion proficiency*

3-Vessel Cord/Ratio/Insertion frequency*

4-Chamber Heart (Abnormal) *

4-Chamber Heart (Abnormal) proficiency*

4-Chamber Heart (Abnormal) frequency*

4-Chamber Heart (Normal) *

4-Chamber Heart (Normal) proficiency*

4-Chamber Heart (Normal) frequency*

ABD/HC Ratio *

ABD/HC Ratio proficiency*

ABD/HC Ratio frequency*

Abdominal Circumference *

Abdominal Circumference proficiency*

Abdominal Circumference frequency*

Bladder *

Bladder proficiency*

Bladder frequency*

Cephalic Index *

Cephalic Index proficiency*

Cephalic Index frequency*

Cerebellum *

Cerebellum proficiency*

Cerebellum frequency*

Cerebral Ventricles *

Cerebral Ventricles proficiency*

Cerebral Ventricles frequency*

Cisterna Magnum *

Cisterna Magnum proficiency*

Cisterna Magnum frequency*

Cystema Magnum *

Cystema Magnum proficiency*

Cystema Magnum frequency*

Diaphragm *

Diaphragm proficiency*

Diaphragm frequency*

Feet *

Feet proficiency*

Feet frequency*

Gender *

Gender proficiency*

Gender frequency*

Femur Length *

Femur Length proficiency*

Femur Length frequency*

Hands *

Hands proficiency*

Hands frequency*

Intraorbital Measurements *

Intraorbital Measurements proficiency*

Intraorbital Measurements frequency*

Head Circumference *

Head Circumference proficiency*

Head Circumference frequency*

Kidneys *

Kidneys proficiency*

Kidneys frequency*

Nose and Lips *

Nose and Lips proficiency*

Nose and Lips frequency*

Placenta Location *

Placenta Location proficiency*

Placenta Location frequency*

Nuchal Fold *

Nuchal Fold proficiency*

Nuchal Fold frequency*

Stomach *

Stomach proficiency*

Stomach frequency*

Ob/Gyn 3rd Tri

Proficiency Rating

Frequency Rating

Amniocentesis (If Applicable) *

Amniocentesis (If Applicable) proficiency*

Amniocentesis (If Applicable) frequency*

High Risk *

High Risk proficiency*

High Risk frequency*

Neonatal Heads *

Neonatal Heads proficiency*

Neonatal Heads frequency*

Cyst Aspiration *

Cyst Aspiration proficiency*

Cyst Aspiration frequency*

Transvaginal Procedures *

Transvaginal Procedures proficiency*

Transvaginal Procedures frequency*

Biopsy Procedures *

Biopsy Procedures proficiency*

Biopsy Procedures frequency*

Aorta *

Aorta proficiency*

Aorta frequency*

Liver/Spleen *

Liver/Spleen proficiency*

Liver/Spleen frequency*

Renal Arteries *

Renal Arteries proficiency*

Renal Arteries frequency*

Legs/Venous *

Legs/Venous proficiency*

Legs/Venous frequency*

OPG Eye *

OPG Eye proficiency*

OPG Eye frequency*

Legs/Arterial *

Legs/Arterial proficiency*

Legs/Arterial frequency*

Segmental Pressures *

Segmental Pressures proficiency*

Segmental Pressures frequency*

Popliteal *

Popliteal proficiency*

Popliteal frequency*

Transcranial *

Transcranial proficiency*

Transcranial frequency*

Equipment

Proficiency Rating

Frequency Rating

Acuson *

Acuson proficiency*

Acuson frequency*

Philips/ATL *

Philips/ATL proficiency*

Philips/ATL frequency*

Philips HP *

Philips HP proficiency*

Philips HP frequency*

GE *

GE proficiency*

GE frequency*

Siemens *

Siemens proficiency*

Siemens frequency*

Toshiba *

Toshiba proficiency*

Toshiba frequency*

Computer Systems

Proficiency Rating

Frequency Rating

AGFA *

AGFA proficiency*

AGFA frequency*

Fuji *

Fuji proficiency*

Fuji frequency*

GE *

GE proficiency*

GE frequency*

Siemens *

Siemens proficiency*

Siemens frequency*

EPIC *

EPIC proficiency*

EPIC frequency*

Cerner *

Cerner proficiency*

Cerner frequency*

Meditech *

Meditech proficiency*

Meditech frequency*

McKesson *

McKesson proficiency*

McKesson frequency*

General Skills

Proficiency Rating

Frequency Rating

Patients in Restraints *

Patients in Restraints proficiency*

Patients in Restraints frequency*

Lifting/Transfer Devices *

Lifting/Transfer Devices proficiency*

Lifting/Transfer Devices frequency*

Cardiac Arrest/CPR *

Cardiac Arrest/CPR proficiency*

Cardiac Arrest/CPR frequency*

Use of Rapid Response Team *

Use of Rapid Response Team proficiency*

Use of Rapid Response Team frequency*

National Patient Safety Goals

Proficiency Rating

Frequency Rating

Accurate Patient Identification *

Accurate Patient Identification proficiency*

Accurate Patient Identification frequency*

Effective Communication *

Effective Communication proficiency*

Effective Communication frequency*

Infection Control *

Infection Control proficiency*

Infection Control frequency*

Universal Precautions *

Universal Precautions proficiency*

Universal Precautions frequency*

Patients in Isolation *

Patients in Isolation proficiency*

Patients in Isolation frequency*

Minimize Risk for Fall *

Minimize Risk for Fall proficiency*

Minimize Risk for Fall frequency*

Certify your information*

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Date*

Skills/Competences

Proficiency

Frequency

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