Peri-Operative RN Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyIV TherapyStart peripheral IV - angio cath(Required) 1 2 3 4 IV Therapy - Assist with:Insertion of A-lines(Required) 1 2 3 4 Insertion of CVP - jugular(Required) 1 2 3 4 Insertion of CVP - sublavian(Required) 1 2 3 4 Insertion of Swan-Ganz(Required) 1 2 3 4 Drawing blood from central line(Required) 1 2 3 4 Drawing venous blood(Required) 1 2 3 4 Administration of blood and productsPacked red blood cells(Required) 1 2 3 4 Plasma/Albumin(Required) 1 2 3 4 Whole blood(Required) 1 2 3 4 General SurgeryAbdominal perineal resection(Required) 1 2 3 4 Adrenalectomy(Required) 1 2 3 4 Anal fissurectomy(Required) 1 2 3 4 Appendectomy(Required) 1 2 3 4 Bowel resection(Required) 1 2 3 4 Breast biopsy(Required) 1 2 3 4 Cholecystectomy (open)(Required) 1 2 3 4 Colectomy(Required) 1 2 3 4 Colostomy/ileostomy(Required) 1 2 3 4 Esophogeal resection(Required) 1 2 3 4 Exploratory laparotomy(Required) 1 2 3 4 Gastrectomy(Required) 1 2 3 4 Gastroplasty(Required) 1 2 3 4 Hemorrhoidectomy(Required) 1 2 3 4 Hemicolectomy(Required) 1 2 3 4 Hepatic resection(Required) 1 2 3 4 Herniorrhaphy - femora(Required) 1 2 3 4 Herniorrhaphy - inguina(Required) 1 2 3 4 Herniorrhaphy - umbilical(Required) 1 2 3 4 Herniorrhaphyhiatal transabdominal/transthoracic(Required) 1 2 3 4 Hiatal hernia repair(Required) 1 2 3 4 Hepatic resection(Required) 1 2 3 4 Insertion - Hickman(Required) 1 2 3 4 Insertion - Groshong(Required) 1 2 3 4 Insertion - Portacath(Required) 1 2 3 4 Hydroceletomy(Required) 1 2 3 4 Imperforate anus reconstruction(Required) 1 2 3 4 Lumbar sympathectomy(Required) 1 2 3 4 Omphalocele repair(Required) 1 2 3 4 Pancreatectomy / pancreatogram(Required) 1 2 3 4 Pilonidal cystectomy(Required) 1 2 3 4 Portal caval shunt(Required) 1 2 3 4 Pyloric stenosis(Required) 1 2 3 4 Radical mastectomy(Required) 1 2 3 4 Saphenous vein ligation and stripping(Required) 1 2 3 4 Sentinel node biopsy(Required) 1 2 3 4 Splenectomy(Required) 1 2 3 4 Tenchknoff duct cyst excision(Required) 1 2 3 4 Thyroglossal duct cyst excision(Required) 1 2 3 4 Thryoidectomy(Required) 1 2 3 4 Vagotomy(Required) 1 2 3 4 Thoracic and Open HeartCervical rib excision(Required) 1 2 3 4 Chamberlain procedure(Required) 1 2 3 4 Closed thoracotomy(Required) 1 2 3 4 Correction pectus excavatum(Required) 1 2 3 4 Esophagectomy(Required) 1 2 3 4 Heller procedure(Required) 1 2 3 4 Mitral commissurotomy(Required) 1 2 3 4 Mitral or aortic valve replacement(Required) 1 2 3 4 IAPB insertion(Required) 1 2 3 4 CABG(Required) 1 2 3 4 Cardiac valve replacement(Required) 1 2 3 4 Patent ductus arteriosus repair(Required) 1 2 3 4 Septal defect repairs(Required) 1 2 3 4 Pacemaker implanation - endocardial(Required) 1 2 3 4 Pacemaker implanation - myocardia(Required) 1 2 3 4 Pacemaker - temporary(Required) 1 2 3 4 Pericardiectomy(Required) 1 2 3 4 Pericardial window(Required) 1 2 3 4 Resection coarctation aorta(Required) 1 2 3 4 Portocaval shunt(Required) 1 2 3 4 Tetrology of fallot(Required) 1 2 3 4 Thoracoplasty(Required) 1 2 3 4 Tracheal resection(Required) 1 2 3 4 Transthoracic diaphragmatic heniorrhaphy(Required) 1 2 3 4 VascularAortic aneurysm with graft replacement(Required) 1 2 3 4 Endarterectomy/carotid - femoral(Required) 1 2 3 4 Fem-pop bypass(Required) 1 2 3 4 Peripheral vascular bypass procedures(Required) 1 2 3 4 Resection carotid aneurysm with graft(Required) 1 2 3 4 Thrombectomy/embolectomy(Required) 1 2 3 4 Vena cava filter/umbrella(Required) 1 2 3 4 Vena cava ligation(Required) 1 2 3 4 NeurologyA-V malformation(Required) 1 2 3 4 Anterior cervical fusion(Required) 1 2 3 4 Anterior laparoscopic spine procedures(Required) 1 2 3 4 Anterior lumbar interbody fusion (ALIF)(Required) 1 2 3 4 Burr holes for subdural hematoma(Required) 1 2 3 4 Carotid ligation(Required) 1 2 3 4 Cervical sympathectomy(Required) 1 2 3 4 Craniectomy for decompression fracture(Required) 1 2 3 4 Discetomy(Required) 1 2 3 4 Hypophysectomy(Required) 1 2 3 4 Insertion nerve stimulators(Required) 1 2 3 4 Insertion medication pumps(Required) 1 2 3 4 Laminectomy(Required) 1 2 3 4 Myelomeningocele repair(Required) 1 2 3 4 Pedicle screw insertion(Required) 1 2 3 4 Posterior lumbar interbody fusion (PLIF)(Required) 1 2 3 4 Shunt procedure/VP, VA/LP(Required) 1 2 3 4 Spine fusion(Required) 1 2 3 4 Ulnar nerve transfer(Required) 1 2 3 4 Ventriculography / ventriculoscopy(Required) 1 2 3 4 Ventriculostomy(Required) 1 2 3 4 Neurology - Cranioplasty/craniotomyClipping of aneurysm(Required) 1 2 3 4 Tumor excision(Required) 1 2 3 4 Stealth crainiotomy(Required) 1 2 3 4 UrologyAdult circumcision(Required) 1 2 3 4 Cystectomy(Required) 1 2 3 4 Cystoscopy/ureteroscopy(Required) 1 2 3 4 Hypospadias repair(Required) 1 2 3 4 Ileal loop(Required) 1 2 3 4 Implants - penile and testicular(Required) 1 2 3 4 Lithotripsy(Required) 1 2 3 4 Nephrectomy(Required) 1 2 3 4 Nephrolithotomy(Required) 1 2 3 4 Prostatectomy - perineal(Required) 1 2 3 4 Orchiopexy(Required) 1 2 3 4 Prostatectomy - perineal(Required) 1 2 3 4 Prostatectomy - supra-pubic(Required) 1 2 3 4 Pyleoplasty(Required) 1 2 3 4 Radical node dissection(Required) 1 2 3 4 Scott incontinence device(Required) 1 2 3 4 TURP(Required) 1 2 3 4 Ureterolithotomy(Required) 1 2 3 4 Vasectomy(Required) 1 2 3 4 Vasovasostomy(Required) 1 2 3 4 Waterhouse procedure(Required) 1 2 3 4 GynecologyCesarean section(Required) 1 2 3 4 Colpotomy(Required) 1 2 3 4 Dilation and curettage (DandC)(Required) 1 2 3 4 Hysterectomy - abdominal(Required) 1 2 3 4 Hysterectomy - vaginal(Required) 1 2 3 4 Marshall - Marchetti(Required) 1 2 3 4 Marsupialization, Bartholin cyst(Required) 1 2 3 4 Ovarian cystectomy(Required) 1 2 3 4 Radium insertion(Required) 1 2 3 4 Salpingo-oophorectomy(Required) 1 2 3 4 Sacral spinus fixation(Required) 1 2 3 4 Shirodkar procedure(Required) 1 2 3 4 Suction curettage(Required) 1 2 3 4 Termination of pregnancy(Required) 1 2 3 4 Tubal ligation(Required) 1 2 3 4 Vaginal recontruction(Required) 1 2 3 4 Vaginectomy/vulvectomy(Required) 1 2 3 4 OrthopedicsAcetabular/pelvic ORIF(Required) 1 2 3 4 Achilles tendon repair(Required) 1 2 3 4 Amputation- leg, arm(Required) 1 2 3 4 Anterior cruciate ligament repair(Required) 1 2 3 4 Application of external fixators - extremeties(Required) 1 2 3 4 Application of external fixators - pelvis(Required) 1 2 3 4 Application of halo traction(Required) 1 2 3 4 Arthrotomy(Required) 1 2 3 4 Bipolar/unipolar hips(Required) 1 2 3 4 Bunionectomy(Required) 1 2 3 4 Calcanel reconstruction(Required) 1 2 3 4 Capsulorrhaphy(Required) 1 2 3 4 Carpal tunnel release(Required) 1 2 3 4 Closed reduction fracture(Required) 1 2 3 4 Hand surgery with implants(Required) 1 2 3 4 Harrington rod instrumentation and / or Dwyer procedure(Required) 1 2 3 4 Heel cord lengthening(Required) 1 2 3 4 Laminectomy(Required) 1 2 3 4 Olecranon bursa, excision of(Required) 1 2 3 4 ORIF, internal fixation with compression set(Required) 1 2 3 4 Patellectomy(Required) 1 2 3 4 PuttiPlatt/Bankart procedure/rotator cuff repair(Required) 1 2 3 4 Reduction with compression sets(Required) 1 2 3 4 Reimplanation of digits(Required) 1 2 3 4 Repair hammer toes(Required) 1 2 3 4 Sacro-iliac (SI) joint screws(Required) 1 2 3 4 Sharrard procedure(Required) 1 2 3 4 Spica cast, application(Required) 1 2 3 4 Spinal fusion(Required) 1 2 3 4 Tendon transplants (hand and foot)(Required) 1 2 3 4 Orthopedics - ArthroscopyAnkle(Required) 1 2 3 4 Elbow(Required) 1 2 3 4 Knee(Required) 1 2 3 4 Shoulder(Required) 1 2 3 4 Orthopedics - Hip compression nails and lag screwsJewett(Required) 1 2 3 4 Kuntscher rod(Required) 1 2 3 4 Lottes(Required) 1 2 3 4 Rush(Required) 1 2 3 4 Schneider(Required) 1 2 3 4 Zimmer(Required) 1 2 3 4 Iliac crest bone graft(Required) 1 2 3 4 Orthopedics - Intramedullary rodsExtraction(Required) 1 2 3 4 Femoral(Required) 1 2 3 4 Humeral(Required) 1 2 3 4 Insertion(Required) 1 2 3 4 Supracondylar(Required) 1 2 3 4 Tibal(Required) 1 2 3 4 Orthopedics - Total joint replacements/revisionsHip(Required) 1 2 3 4 Knee(Required) 1 2 3 4 Shoulder(Required) 1 2 3 4 PlasticsAbdominal lipectomy(Required) 1 2 3 4 Abdominalplasty(Required) 1 2 3 4 Blepharoplasty(Required) 1 2 3 4 Cleft lip repair(Required) 1 2 3 4 Dermabrasion(Required) 1 2 3 4 Face lift(Required) 1 2 3 4 Mentoplasty(Required) 1 2 3 4 Otoplasty(Required) 1 2 3 4 Pedicle grafts(Required) 1 2 3 4 Rhytidectomy(Required) 1 2 3 4 Scar revisions(Required) 1 2 3 4 Split thickness skin grafting(Required) 1 2 3 4 Tissue expanders(Required) 1 2 3 4 Plastics - MammoplastyAugmentation(Required) 1 2 3 4 Reduction(Required) 1 2 3 4 Tramflaps with reconstructive mammoplasty(Required) 1 2 3 4 Tramflaps with reconstructive mammoplastyAdenoidectomy(Required) 1 2 3 4 Caldwell - Luc(Required) 1 2 3 4 Cleft lip/palate repair(Required) 1 2 3 4 Closed reduction nasal fx(Required) 1 2 3 4 Ethmoidectomy(Required) 1 2 3 4 Fenestration procedure(Required) 1 2 3 4 Frontal flap sinus procedure(Required) 1 2 3 4 Glossectomy(Required) 1 2 3 4 Laryngectomy(Required) 1 2 3 4 Mandibulectomy(Required) 1 2 3 4 Mastoidectomy(Required) 1 2 3 4 Maxillary advancement with graft(Required) 1 2 3 4 Maxillectomy(Required) 1 2 3 4 Myringoplasty(Required) 1 2 3 4 Myringotomy with PE tube insertion(Required) 1 2 3 4 Nasal polypectomy(Required) 1 2 3 4 Open reducation facial fx(Required) 1 2 3 4 Open reducation nasal fx(Required) 1 2 3 4 Parotidectomy(Required) 1 2 3 4 Pharyngeal flap procedure(Required) 1 2 3 4 Radical neck dissection(Required) 1 2 3 4 Ranulectomy(Required) 1 2 3 4 Rhinoplasty/septoplasty(Required) 1 2 3 4 Selective osteotomy of maxilla/mandible(Required) 1 2 3 4 Sinus endoscopy(Required) 1 2 3 4 Sinusotomy(Required) 1 2 3 4 Stapedectomy(Required) 1 2 3 4 Submucous resection(Required) 1 2 3 4 Tonsillectomy(Required) 1 2 3 4 Tracheostomy(Required) 1 2 3 4 Tympanoplasty(Required) 1 2 3 4 OralClosed reducation facial fractures/wiring(Required) 1 2 3 4 Excision odontoma(Required) 1 2 3 4 Excision of deciduous teeth(Required) 1 2 3 4 Extraction of impacted molars(Required) 1 2 3 4 Fractured jaws, mandibular and zagomatic(Required) 1 2 3 4 Ginivectomy(Required) 1 2 3 4 LeFort osteotomies(Required) 1 2 3 4 Maxillary procedure with graft(Required) 1 2 3 4 Pediatric dentistry(Required) 1 2 3 4 Sagittal osteotomy(Required) 1 2 3 4 Temporomandibular (TMJ) with arthroplasty(Required) 1 2 3 4 OphthalmologyCataract extraction with IOL(Required) 1 2 3 4 Corneal transplant(Required) 1 2 3 4 Dacryocystectomy(Required) 1 2 3 4 Eye enucleation(Required) 1 2 3 4 Exicison of chalazion(Required) 1 2 3 4 Canthotomy(Required) 1 2 3 4 Correction of ectropian/entropian(Required) 1 2 3 4 Enucleation(Required) 1 2 3 4 Iridectomy(Required) 1 2 3 4 Lacrimal duct probing(Required) 1 2 3 4 Lid and muscle procedures(Required) 1 2 3 4 Orbital implant(Required) 1 2 3 4 Phaco emulsification(Required) 1 2 3 4 Ptergium repair(Required) 1 2 3 4 Recession resection(Required) 1 2 3 4 Refractive keratoplasty(Required) 1 2 3 4 Repair orbital blowout fracture(Required) 1 2 3 4 Repair of retinal detachment(Required) 1 2 3 4 Scleral buckle(Required) 1 2 3 4 Vitrectomy(Required) 1 2 3 4 Endoscopic ProceduresEndoscopic Procedures(Required) 1 2 3 4 Colonscopy(Required) 1 2 3 4 Culdoscopy(Required) 1 2 3 4 Esophagoscopy(Required) 1 2 3 4 Gastroscopy(Required) 1 2 3 4 Hysteroscopy(Required) 1 2 3 4 Laparoscopic proceduresAppendectomy(Required) 1 2 3 4 Cholecystectomy / cholangiogram(Required) 1 2 3 4 Colon resection(Required) 1 2 3 4 Diagnostic(Required) 1 2 3 4 Nissen fundoplication(Required) 1 2 3 4 Salpingo-oophorectomy(Required) 1 2 3 4 Tubal ligation(Required) 1 2 3 4 Vaginal hysterectomy(Required) 1 2 3 4 Larynoscpy and microlaryngoscopy(Required) 1 2 3 4 Mediastinoscopy(Required) 1 2 3 4 Pelviscopy(Required) 1 2 3 4 Sigmoidoscopy(Required) 1 2 3 4 Thoracoscopy(Required) 1 2 3 4 ThoracoscopyBone(Required) 1 2 3 4 Bone marrow(Required) 1 2 3 4 Corneal transplant(Required) 1 2 3 4 Harvesting(Required) 1 2 3 4 Heart(Required) 1 2 3 4 Liver(Required) 1 2 3 4 Lung(Required) 1 2 3 4 Multi-organ(Required) 1 2 3 4 Pancreas(Required) 1 2 3 4 Skin(Required) 1 2 3 4 AccidentsMotor vehile accidents (multiple injuries)(Required) 1 2 3 4 Traumatic amputations(Required) 1 2 3 4 Trauma - Gunshot/stab woundsAbdomen(Required) 1 2 3 4 Chest(Required) 1 2 3 4 Head(Required) 1 2 3 4 EquipmentAbdomen(Required) 1 2 3 4 Chest(Required) 1 2 3 4 Head(Required) 1 2 3 4 HeadArgon beam coagulator(Required) 1 2 3 4 Bair hugger(Required) 1 2 3 4 Blood/fluid warmer(Required) 1 2 3 4 Cardiac monitor and pacemaker(Required) 1 2 3 4 Cell saver(Required) 1 2 3 4 Cidex soak(Required) 1 2 3 4 Cry-opthalmic unit(Required) 1 2 3 4 Defibrillator/pacer(Required) 1 2 3 4 Electrosurgical unit(Required) 1 2 3 4 Emerson thoracic pump(Required) 1 2 3 4 ETO sterilizer(Required) 1 2 3 4 Eye magnet(Required) 1 2 3 4 Fiber optic luminator(Required) 1 2 3 4 Flash autoclave(Required) 1 2 3 4 Hypo/hyperthemia units(Required) 1 2 3 4 Kreiselman resuscitor(Required) 1 2 3 4 Mesh graft(Required) 1 2 3 4 MicroscopesNerve stimulatorNitrous oxide bank(Required) 1 2 3 4 Nitrous oxide bank(Required) 1 2 3 4 Ohio suction units(Required) 1 2 3 4 Orthopedic arm board with drain(Required) 1 2 3 4 Pleurevac disp. chest drainage(Required) 1 2 3 4 Pneumatic tourniquet(Required) 1 2 3 4 Sterad machine(Required) 1 2 3 4 Steri-vac aeratopm cabinet(Required) 1 2 3 4 Steris unit(Required) 1 2 3 4 Tele therometer(Required) 1 2 3 4 Ultrasonic cleaner(Required) 1 2 3 4 Vac-pac positioner(Required) 1 2 3 4 Vacuum curettage(Required) 1 2 3 4 Washer sanitizer(Required) 1 2 3 4 Washer sterilizer(Required) 1 2 3 4 Equipment - Fracture tablesChick/Marquet tables(Required) 1 2 3 4 Jackson table(Required) 1 2 3 4 Rush/Skytron tables(Required) 1 2 3 4 Equipment - Intestinal stapling devicesEEA(Required) 1 2 3 4 GIA(Required) 1 2 3 4 LDS(Required) 1 2 3 4 TA(Required) 1 2 3 4 Equipment - LaserCO2(Required) 1 2 3 4 Eye magnet(Required) 1 2 3 4 Yag(Required) 1 2 3 4 Other(Required) 1 2 3 4 Camera/video systemsCamera controller(Required) 1 2 3 4 Light source(Required) 1 2 3 4 Printers(Required) 1 2 3 4 VCRs(Required) 1 2 3 4 DermatomeBrown(Required) 1 2 3 4 Padgett(Required) 1 2 3 4 Zimmer(Required) 1 2 3 4 Disposable grounding pads(Required) 1 2 3 4 Drills3-M maxi driver(Required) 1 2 3 4 Codman craniotome(Required) 1 2 3 4 Hall air-driver(Required) 1 2 3 4 Hall dental(Required) 1 2 3 4 Hall neurotome(Required) 1 2 3 4 Midax Rex/Anspach(Required) 1 2 3 4 Minidriver(Required) 1 2 3 4 Stryker drills - large battery(Required) 1 2 3 4 Stryker drills - small battery(Required) 1 2 3 4 Surgairtome(Required) 1 2 3 4 Synthes A-O drill(Required) 1 2 3 4 Electrosurgical unit(Required) 1 2 3 4 MiscellaneousAssist with intubation(Required) 1 2 3 4 Conscious sediation administration(Required) 1 2 3 4 Conscious sediation monitoring(Required) 1 2 3 4 Management of malignant hypertensive crisis(Required) 1 2 3 4 Able to assure a safe environment for the specific needs of various age groupsA.Newborn/Neonate (birth - 30 days)(Required) 1 2 3 4 B.Infant (30 days - 1 year)(Required) 1 2 3 4 C.Toddler (1 - 3 years)(Required) 1 2 3 4 D.Preschooler (3 - 5 years)(Required) 1 2 3 4 E.School age children (5 - 12 years)(Required) 1 2 3 4 F.Adolescents (12 - 18 years)(Required) 1 2 3 4 G.Young adults (18 - 39 years)(Required) 1 2 3 4 H.Middle adults (39 - 64 years)(Required) 1 2 3 4 I.Older adults (64+)(Required) 1 2 3 4 Able to communicate and/or instruct patients according to their age, maturity, comprehensionA.Newborn/Neonate (birth - 30 days)(Required) 1 2 3 4 B.Infant (30 days - 1 year)(Required) 1 2 3 4 C.Toddler (1 - 3 years)(Required) 1 2 3 4 D.Preschooler (3 - 5 years)(Required) 1 2 3 4 E.School age children (5 - 12 years)(Required) 1 2 3 4 F.Adolescents (12 - 18 years)(Required) 1 2 3 4 G.Young adults (18 - 39 years)(Required) 1 2 3 4 H.Middle adults (39 - 64 years)(Required) 1 2 3 4 I.Older adults (64+)(Required) 1 2 3 4 Evaluate age-appropriate behavior, motor skills and physiological normsA.Newborn/Neonate (birth - 30 days)(Required) 1 2 3 4 B.Infant (30 days - 1 year)(Required) 1 2 3 4 C.Toddler (1 - 3 years)(Required) 1 2 3 4 D.Preschooler (3 - 5 years)(Required) 1 2 3 4 E.School age children (5 - 12 years)(Required) 1 2 3 4 F.Adolescents (12 - 18 years)(Required) 1 2 3 4 G.Young adults (18 - 39 years)(Required) 1 2 3 4 H.Middle adults (39 - 64 years(Required) 1 2 3 4 I.Older adults (64+)(Required) 1 2 3 4 AuthorizationsLegal 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 You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. 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.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
