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 SETTINGSAdult Home Health1234Psych Home Health1234Pedi Home Health1234Home Infusion1234Home Health Hospice1234CardiovascularAngina1234Congestive Heart Failure1234Coronary Artery Bypass Graft Surgery1234Coronary Artery Disease1234Heart Sounds1234Hypertension1234Myocardial Infarction1234Pacemaker/Internal Defibrillator1234Peripheral pulse/circulation checks1234Documentation GuidelinesAdmission Assessment1234Case management1234Discharge/discharge due to safety or Non compliance1234Recertification1234Resumption of care1234Routine visit1234Significant change in condition 41234Start of Care1234Transfer1234Endocrine/ MetabolicBlood Glucose/glucometer management1234Cushing’s/Addison’s disease1234Diabetes1234Hyper/Hypoglycemia1234Hypo/Hyperthyroidism1234Insulin Pump Management1234GastrointestinalBowel obstruction1234Colostomy/ileostomy management/care1234G-tube site care1234Hepatitis/liver failure1234Management of feeding tubes1234NG tube management/care1234Nutritional Assessment1234Post GI surgery1234Ulcerative Colitis1234Genitourinary/RenalAcute Renal Failure1234Chronic Renal Failure1234Post AV Fistula/Shunt1234Post urology surgery1234Suprapubic Catheter insertion/management1234Urinary Catheter insertion/ management1234Urinary Tract Infection1234Infectious Disease1234C-Difficile1234HIV1234MRSA1234Tuberculosis1234VRE (Vancomycin Resistant Enterococci Infection)1234IntegumentaryBurns1234Drain Management1234Herpes Zoster1234Leg ulcers1234Necrotizing Fasciitis1234Pressure ulcer prevention/management1234Pressure ulcer staging1234Pressure Ulcers1234Wound care1234Wound V.A.C management1234Maternal /Child WellnessBreast feeding support1234Contractions1234Newborn care1234Phototherapy1234Post partum mother/baby visit1234Pregnancy related complications1234Restricted bedrest1234Medication Administration/ManagementMedication Assessment/Management1234Pain Management/Assessment1234PCA pump management1234Utilization of pain scales (verbal, nonverbal)1234NeurologicalAlzheimer’s/Dementia1234Brain tumor or injury1234CVA1234Degenerative Neurologic Disorders1234F.A.S.T protocol for stroke1234Level of consciousness changes1234Paralysis1234Seizure1234Seizure precautions1234OncologyLiquid/solid tumors1234Monitoring Chemotherapy side effects1234Neutropenic precautions1234Pain management/hospice1234Port insertion/care1234Radiation/chemotherapy treatment1234Symptom management1234Terminal cancer1234OrthopedicsCast/brace/immobilizer device care1234DVT prophylaxis /recognition1234Fractures1234Lift/ Assistive device management1234Osteoarthritis1234Osteomyelitis1234Post amputation1234Post Total Joint Replacement1234PediatricsCalculation of Pediatric Dosages1234Cystic fibrosis1234Feeding tube care/management1234Muscular dystrophy1234Post cardiac surgery1234Respiratory distress syndrome1234Sickle cell disease1234Spina bifida1234Tracheostomy care/management1234Ventilator care/ management1234Phlebotomy/IV ManagementAdministration of blood/blood products1234Care and management of peripheral IVs/ central lines/ports1234Infusion pump management1234IV start skills1234Phlebotomy skills1234Professional Knowledge and SkillsClinical assessment documentation1234Coordinate services1234Infection Control Precautions1234Inteional patient safety goals1234Palrpretation and Management of lab values1234Natliative symptom management1234Post death protocols1234PsychiatricCognitive disorders1234Communication tactics1234De-escalation techniques1234Mood disorders1234Safety precautions1234Schizophrenia/Psychotic disorders1234RespiratoryAsthma1234BiPAP/CPAP management/maintenance1234COPD1234Incentive spirometry utilization/teaching1234Lung cancer1234Nebulizer utilization/teaching1234Oxygen safety/administration1234Pneumonia/respiratory infection1234Pulmonary Emboli1234Tracheostomy care1234Ventilator management/maintenance1234COMPUTERIZED CHARTINGCerner1234EPIC1234McKesson1234Meditech1234OASIS1234EMR1234Homecare Homebase1234Other :1234IF OTHER, PLEASE SPECIFY :Age specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit
