Please enable JavaScript in your browser to complete this form.Personal InformationName *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 SettingsEmergency Department Adult1234Emergency Department Pediatric 1234Level I Trauma Center1234Level II Trauma Center1234Non Trauma Emergency Department1234Cardiac Monitoring and Emergency ResponseCardioversion1234Defibrillation1234Interpretation of 12 Lead EKG1234Interpretation of dysrhythmias1234Cardioversion (copy)1234Management of cardiac arrest1234Obtain 12 lead EKG1234Cardiac –Care of the PatientAcute Coronary Syndrome1234Aneurysm1234CHF1234Hypertensive Crisis1234Hypertensive Crisis1234EENTCorneal abrasion1234Dental trauma1234Ear foreign body1234Epistaxis1234Eye foreign body1234Facial trauma1234Nose foreign body1234EndocrineDKA1234Hyperglycemia1234Hypoglycemia1234GastrointestinalAbdominal pain1234Abdominal trauma1234GI bleed1234Liver disease1234Genitourinary/RenalChronic/Acute Renal failure1234Renal Calculi1234Renal Trauma1234Testicular Torsion1234IV therapy/PhlebotomyArterial line management1234Blood Product Administration1234Central line care/management1234Intra-Osseous infusion1234Midline Insertion1234Phlebotomy1234PICC line insertion1234Starting IVs1234MedicationsAnti-Arrhythmic1234Anticoagulants1234Anti-Hypertensives1234Anti-Seizure Medications1234Continuous IV paralytics1234Continuous IV sedation1234Emergency Medications1234Insulin1234IV vasopressors1234IV vasopressors1234Procedural Sedation Administration1234Reversal agents1234Thrombolytic Agents1234Automated Medication Dispensing SystemsOmnicell1234Pyxis1234Accu Dose1234Bar Code Medication Administration1234NeurologicalCVA1234Lumbar Puncture1234Meningitis1234Seizures1234Spinal Cord Injury1234Stroke scale assessment1234Traumatic Brain injury1234OrthopedicsCirculation Checks1234Crutch Training1234Fractures/Casting1234Manage / Apply Splints1234Open/Complex Fractures1234PediatricsAbdominal Pain1234Asthma1234Burns1234Digestive Disorders1234Epiglottitis1234Head Injury1234Hyperglycemia1234Identifying and Reporting Abuse1234Infections1234Mental/behavioral Health Conditions1234Musculoskeletal Disorders1234Near Drowning1234Poison Ingestion1234Respiratory Infections1234Seizures1234Sickle Cell Crisis1234Skin Disorders1234Spinal Cord Injury1234Urinary Tract Infections1234PsychiatricAcute psychosis1234Psychiatric Hold1234Drug Overdose1234Managing Violent Behavior1234Substance Withdrawal/ ETOH withdrawal1234Suicidal patient1234RespiratoryAirway Obstruction1234Aspiration1234Chest Tube Insertion/Management1234COPD/Asthma1234Interpretation of ABGs1234Intubation1234Pneumonia1234Pneumothorax1234Pulmonary Edema1234Respiratory Failure1234Ventilated Patients1234Shock/Trauma2nd Degree Burns12343rd Degree Burns1234Anaphylactic Shock1234Cardiogenic Shock1234Drowning1234Gunshot wounds1234Hazardous Substance Exposure1234Hypovolemic Shock1234Neurogenic Shock1234Septic Shock1234Traumatic amputation1234Women’s HealthEctopic Pregnancy1234Fetal heart tones1234Pelvic Inflammatory Disease/STD1234Precipitous Delivery1234Pregnancy Induced hypertension1234Reporting Acts of Violence1234Sexual Assault1234Professional Topics and SkillsAMA Procedures1234Ambulance/Paramedic Radio1234Child Passenger Safety Training1234EMTALA1234Fall Risk Assessment1234Infection Prevention1234Interpretation and Communication of Lab Values1234Isolation Precautions1234National Patient Safety Goals/Core Measures1234Pain Assessment Management1234Pressure Ulcer Assessment/Prevention1234Restraint Use1234Triage1234COMPUTERIZED CHARTINGCerner1234EPIC1234McKesson1234Meditech1234Allscripts1234OASIS1234MIDAS1234Other:1234If Other, Please specifyAge Specific CompetencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit