Flu Clinic/Clinic Checklist

Flu Clinic/Clinic Skills Checklist

One program to handle all talent management needs from acquisition to development

Personal Information

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Overall Score

Name(Required)

First Middle Last

Last 4 Digits of Social Security Number

Email(Required)

Hidden

Date

Proficiency Scale

1 – No Experience
2 – Need Training
3 – Able to perform with supervision
4 – Able to perform independently

Administrative Skills

Schedule and manage appointments(Required)

Organize and maintain patient's medical record(Required)

Utilize electronic health records for accurate patient documentation(Required)

Demonstrate telephone techniques(Required)

Billing & Coding

ICD-9 Coding(Required)

ICD-10 Coding(Required)

CPT Coding(Required)

Insurance billing(Required)

Provision of Care

Obtain and analyze vital signs(Required)

Perform comprehensive physical patient assessment(Required)

Obtain and document patient history(Required)

Obtain and document patient allergies(Required)

Recognize abnormal assessment findings and intervene accordingly(Required)

Prioritize responsibilities for effective safe patient care(Required)

Utilize two patient identifiers prior to treatments, procedures, and medication administration(Required)

Utilize multiple screening tools (hearing test, vision test, developmental test)(Required)

Telephone triage procedures(Required)

Laboratory test interpretation(Required)

Radiology test interpretation(Required)

EKG interpretation(Required)

Develop and maintain nursing care plan(Required)

Determine time and time intervals(Required)

Determine start and stop times for time intervals(Required)

Determine time using military time and analog clock(Required)

Activate and participate in emergency response plan for emergency situations(Required)

Perform Basic Life Support, CPR, and Heimlich maneuver(Required)

Utilize AED for emergency situations(Required)

Initiate patient referrals to other healthcare agencies(Required)

Maintain proper body mechanics(Required)

Understand and follow physicians orders(Required)

Maintain and apply safety/risk protocols for fall precautions(Required)

Maintain and apply safety/risk protocols for suicide precautions(Required)

Perform pain assessment(Required)

Apply non-pharmacological techniques for pain when appropriate (diversion, relaxation, breathing, etc.)(Required)

Assess post-surgical patient for complications(Required)

Perform nursing interventions for end of life care(Required)

Assess and manage a variety of drains (surgical, wound, etc.)(Required)

Perform wound/pressure ulcer staging assessment and classification.(Required)

Assess for drug/alcohol dependence and withdrawal.(Required)

Infection Control

Adhere to hand washing guidelines(Required)

Maintain aseptic technique(Required)

Maintain Universal Precautions(Required)

Maintain sterile technique when appropriate(Required)

Utilize Isolation Precautions when appropriate(Required)

Utilize Personal Protective Equipment when indicated(Required)

Disposal of biohazardous materials(Required)

Maintain clean environment utilizing environmental cleaning procedures(Required)

Professional Practice

1. Patient Advocacy:

Recognition and reporting of suspected abuse/neglect for all age groups(Required)

Demonstrate assertiveness & initiate advocacy for patients(Required)

Utilize chain of command to ensure safe patient care(Required)

Abide by Advance Directives (Living Wills, Health Care Proxy, Power of Attorney for Health Care)(Required)

2. Professional Issues

Maintain privacy and dignity for each patient(Required)

Maintain patient confidentiality per HIPAA guidelines(Required)

Identify and respond to issues of confidentiality(Required)

Complies with Joint Commission, NPSG, CMS, and other federal/state regulations and guidelines(Required)

Report incidents as indicated and follow protocols for incidents(Required)

Report patient conditions as indicated by federal/state regulations and guidelines (abuse/neglect, communicable diseases, gunshot wound, dog bite)(Required)

3. I acknowledge and understand the Joint Commission's list of

"Do Not Use Abbreviations"(Required)

Yes

4. Interdisciplinary Communication*

Communicate accurately and effectively in English, both written and verbal(Required)

Communicate with patient using age and cultural appropriate methods(Required)

Respond to and initiate written communication(Required)

Recognize and respond to verbal communication(Required)

Recognize and respond to nonverbal communication(Required)

Collaborate with interdisciplinary teams for care of patient(Required)

Utilize SBAR communication(Required)

Utilize problem-solving/decision-making techniques(Required)

Give and receive reports from other healthcare professionals regarding patient care(Required)

Delegate effectively to licensed and non-licensed personnel(Required)

Laboratory

1. Specimen Collection:

Venipuncture(Required)

Central line blood draws(Required)

Capillary puncture(Required)

Throat specimen collection(Required)

Urine specimen collection(Required)

Stool specimen collection(Required)

Suptum specimen collection(Required)

Tissue specimen collection(Required)

2. Laboratory testing:

Use methods for quality testing(Required)

Perform urinalysis testing(Required)

Perform glucometer testing(Required)

Perform pediatric screenings (PKU)(Required)

Medication Administration

1. Provision of Care:

Utilize 6 rights of medication administration(Required)

Utilize dosage calculation formulas for accurately determine medication dosages(Required)

Maintain medication and immunization records(Required)

Provide education to patient regarding medications(Required)

Obtain history regarding contraindications(Required)

Obtain history regarding anaphylactic/allergy reactions(Required)

Assess for therapeutic response, expected outcomes(Required)

Assess for and manage adverse reactions(Required)

Waste medications (utilize proper procedures and documentation)(Required)

2. Administer medications through a variety of routes:

Topical(Required)

Oral(Required)

Intradermal injection(Required)

Intramuscular injection(Required)

Subcutaneous injection(Required)

IV push(Required)

IV infusion(Required)

3. Types of medication administration:

Blood transfusion(Required)

Chemotherapy(Required)

Insulin(Required)

Drug overdose treatment(Required)

Antibiotics(Required)

Narcotics(Required)

IV Fluids(Required)

Muscle relaxers(Required)

Anit-anxiety(Required)

Sedatives(Required)

Anticoagulant therapy(Required)

4. Immunizations:

Determine eligibility to receive vaccine(Required)

Provide patient education in relation to vaccines(Required)

PPD placement and reading results(Required)

Flu vaccine(Required)

Pneumococcal vaccine(Required)

Varicella(Required)

DTaP(Required)

MMR(Required)

HepA(Required)

HepB(Required)

HPV(Required)

Rotavirus(Required)

IPV(Required)

Hib(Required)

HPV(Required)

Meningococcal(Required)

Patient Education

Identify needs for health maintenance and disease prevention(Required)

Provide instruction for health maintenance and disease prevention(Required)

Instruct individuals according to their needs(Required)

Instruct and demonstrate use and care of patient equipment(Required)

Explain general office policies(Required)

Procedures

Provide education and patient preparation for invasive procedures(Required)

Obtain patient consent for treatments and procedures(Required)

Perform time-out procedure(Required)

Provide Central line/PICC line care(Required)

Ear lavage(Required)

Placement and management of peripheral IV(Required)

Assist with Doppler exams(Required)

Assist with simple biopsy(Required)

Assist with I&D(Required)

Assist with lumbar puncture(Required)

Assist with wound debridement's(Required)

Assist with Colposcopy(Required)

Assist with Urodynamic Studies(Required)

Assist with IUD insertions(Required)

Assist with bone marrow biopsy(Required)

Assist with setting of simple bone fractures(Required)

Assist with suturing(Required)

Removal of sutures/staples(Required)

Application of casts/splints(Required)

Sterile dressing changes(Required)

Non-sterile dressing changes(Required)

Oxygen administration(Required)

Accessing venous ports(Required)

Measurement and application of anti-embolic stockings(Required)

Instruct/educate patient to use incentive spirometer(Required)

Place and manage nasogastric tube(Required)

Perform oral and nasopharyngeal suctioning(Required)

Insert and remove indwelling urinary catheter(Required)

Insert and remove straight urinary catheter(Required)

Patient Care Settings

General Clinic (more than 5 MDs in practice)(Required)

General Clinic (less than 5 MDs in practice)(Required)

General Internal Medicine(Required)

Allergy Clinic(Required)

Endocrinology(Required)

Gastroenterology(Required)

Health/Wellness Screening(Required)

OB/GYN(Required)

Occupational Health(Required)

Oncology(Required)

Orthopedics(Required)

Pediatrics(Required)

Rehab Clinic(Required)

Rheumatology(Required)

Surgical Practice(Required)

Utilization Review/Case Management(Required)

Age Specific:

Please indicate the frequency with which you provide care for each age group:*

Infant (Birth to 1 year)(Required)

Toddler (1-3 years)(Required)

Pre-school (3-6 years)(Required)

School Age (6-12 years)(Required)

Adolescent ( 12-18 years)(Required)

Young Adult ( 18-30 years)(Required)

Mature Adult (30-60 years)(Required)

Elderly (>60 years)(Required)

Authorizations

Legal Consent(Required)

I agree to the terms and conditions.

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
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The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

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