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PT/PTA Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | ADULT | 1 | 2 | 3 | 4 | ||
| Orthopedic | |||||||
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Neck Injuries / Surgeries | ||||||
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Back Injuries / Surgeries | ||||||
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Hip Fractures / Injuries | ||||||
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Total Hip Replacement | ||||||
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Knee Injuries | ||||||
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Total Knee Replacement | ||||||
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Upper Extrem Joint Replacements | ||||||
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Shoulder Injuries | ||||||
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Degen. Joint Disease / Arthritis | ||||||
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Hand Injuries | ||||||
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Temporomandibular Joint (TMJ) | ||||||
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Post Operative Care | ||||||
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Amputations | ||||||
| Neurologic | |||||||
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Stroke Rehabilitation | ||||||
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Cognitive Disorders | ||||||
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Head Trauma | ||||||
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Spinal Cord Injury | ||||||
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Functional Splinting | ||||||
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Adaptive Equipment-Wheelchair | ||||||
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Neuromuscular Diseases | ||||||
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Multiple Sclerosis | ||||||
| Rating Stars (Click) | ADULT | 1 | 2 | 3 | 4 | ||
| Prosthetics / Orthotics | |||||||
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Upper Extremity Prosthetics | ||||||
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Above Knee Prosthetics | ||||||
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Below Knee Prosthetics | ||||||
| Rating Stars (Click) | Sports Medicine | 1 | 2 | 3 | 4 | ||
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LIDO | ||||||
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Nautilus / Eagle | ||||||
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Taping | ||||||
| Prosthetics / Orthotics | |||||||
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Other | ||||||
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Chest PT | ||||||
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Cardiac Rehab | ||||||
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ICU Procedures | ||||||
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CCU Procedures | ||||||
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SICU Procedures | ||||||
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Burn Management | ||||||
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Work Hardening - Work Site Eval | ||||||
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Work Capacity Eval | ||||||
| Rating Stars (Click) | Procedures / Treatments: | 1 | 2 | 3 | 4 | ||
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Ankle / Foot Orthosis | ||||||
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Slings | ||||||
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Splints - Wrist / Hand | ||||||
| Procedures / Treatments | |||||||
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CPM Machine | ||||||
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Hydrotherapy | ||||||
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Whirlpool | ||||||
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Hubbard Tank | ||||||
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Therapeutic Pool | ||||||
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TENS | ||||||
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Electrical Stimulation | ||||||
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Ultrasound | ||||||
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Cryotherapy | ||||||
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Massage | ||||||
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Diathermy | ||||||
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Acupressure | ||||||
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Spinal Mobilization | ||||||
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Extremity Mobilization | ||||||
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Myofacial Release | ||||||
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Craniosacral Techniques | ||||||
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Cervical Traction | ||||||
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Lumbar Traction | ||||||
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Activities of Daily Living | ||||||
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Gait Training | ||||||
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transfers | ||||||
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Sports Medecine | ||||||
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Athletic Injuries | ||||||
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Biodex | ||||||
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Cybex | ||||||
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Orthotron | ||||||
| Rating Stars (Click) | Other | 1 | 2 | 3 | 4 | ||
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Functional Capacity Eval | ||||||
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Muscle Energy Techniques | ||||||
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Activities of Daily Living | ||||||
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Universal Precautions | ||||||
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Skilled Nursing Documentation | ||||||
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Medicare A | ||||||
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Medicare B | ||||||
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State Healthcare | ||||||
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Skilled Nursing Documentation | ||||||
| Rating Stars (Click) | AGE | 1 | 2 | 3 | 4 | ||
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Newborn (birth-30 days) | ||||||
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Infant (30 days - 1 year) | ||||||
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Toddler (1 - 3 years) | ||||||
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Preschooler (3 - 5 years) | ||||||
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School Age (5 - 12 years) | ||||||
| Rating Stars (Click) | AGE | 1 | 2 | 3 | 4 | ||
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Adolescents (12 - 18 years) | ||||||
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Young Adults (18 - 39 years) | ||||||
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Middle Adults (39 - 64 years) | ||||||
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Older Adults (64+ years) | ||||||