Please enable JavaScript in your browser to complete this form.Personal InformaationName *FirstLastPlease enter your full legal name as it appears on your Social Security Card.Email *Phone No experience: requires education, training and supervision Intermittent experience: may need support or supervise Proficient: consistent experience, independent Expert level: can teach/supervise others. Work Settings :Home Health/Hospice setting1234Home Hospice1234Inpatient Hospice1234Pediatric Hospice1234Skilled Nursing1234Care of Patient with:Cardiac Conditions1234General Debility1234GI/Hepatic1234HIV/AIDS1234Neoplastic Conditions1234Neurological Conditions1234Pulmonary Conditions1234Renal Conditions1234End of Life CareAfter treatment (survivorship)1234Bereavement planning1234Cultural awareness1234Death/dying counseling1234Identify Spiritual needs1234Perideath care of family1234Postmortem Care1234Death pronouncement1234Ethical and Legal IssuesAdvanced directives1234Medical futility1234Medical abandonment1234Organ donation1234Palliative sedation1234Withholding/withdrawing treatment1234Medication administration/ Pain management(WHO) Analgesic Ladder1234Adjuvant therapy1234Breakthrough dosing1234Calculation of Pediatric Dosages1234Equianalgesic dosing of opioids1234Medication tolerance1234Pain assessment1234PCA pump management1234Pharmacologic/non-pharmacological pain interventions1234Proper disposal of medications1234Types of pain (somatic, visceral, neuropathic) and treatment1234Utilization of pain scales (verbal, nonverbal)1234PediatricsDevelopmentally appropriate grief support for children1234Developmentally appropriate pain assessment/management1234Parental/Sibling Support1234Pediatric team collaboration1234Phlebotomy/IV ManagementPhlebotomy skills1234IV start skills1234Care and management of peripheral IVs/ central lines/ports1234Infusion pump management1234Professional Knowledge/skillsDME authorization of necessity1234Effective communication skills (5 step approach)1234Goal setting with patient/family1234Individual plan of care1234Intake assessment/interview1234Medicare state regulations1234OASIS1234Patient/Family education and support1234Positioning/preventive shearing and pressure ulcers1234Symptom Assessment/ManagementAlteration in skin and mucous membranes1234Altered mental status1234Anorexia and Cachexia1234Aphasia1234Ascites1234Constipation/diarrhoea1234Nausea/vomiting1234Dysphagia1234Edema1234Fatigue/lethargy/weakness1234Hematologic symptoms1234Myoclonus1234Pressure ulcer staging1234COMPUTERIZED CHARTINGCerner1234EPIC1234McKesson1234McKesson1234Meditech1234OASIS1234EMR1234Other :1234Paragraph TextAge specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit