Physical Therapy 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 independentlyWork SettingsAdult/adult ICU(Required) 1 2 3 4 Children’s hospital(Required) 1 2 3 4 General acute care(Required) 1 2 3 4 Home health care(Required) 1 2 3 4 Outpatient neuro(Required) 1 2 3 4 Outpatient ortho(Required) 1 2 3 4 Pediatrics/PICU(Required) 1 2 3 4 Psychiatric hospital(Required) 1 2 3 4 School setting(Required) 1 2 3 4 Early intervention(Required) 1 2 3 4 Subacute(Required) 1 2 3 4 OrthopedicsUpper extremities(Required) 1 2 3 4 Arthritis programs(Required) 1 2 3 4 Back syndrome(Required) 1 2 3 4 Cervical injuries(Required) 1 2 3 4 Chronic fatigue syndrome(Required) 1 2 3 4 Fibromyalgia(Required) 1 2 3 4 Halo traction(Required) 1 2 3 4 Hand injury(Required) 1 2 3 4 Hip fracture(Required) 1 2 3 4 Kyphoplasty(Required) 1 2 3 4 Manual therapy(Required) 1 2 3 4 Mobilization techniques(Required) 1 2 3 4 Pelvic fracture(Required) 1 2 3 4 Postpolio syndrome(Required) 1 2 3 4 Shoulder injuries(Required) 1 2 3 4 TMJ dysfunction(Required) 1 2 3 4 Total hip/total knee(Required) 1 2 3 4 Total joint replacement(Required) 1 2 3 4 Total shoulder/CPM(Required) 1 2 3 4 NeurologicALS(Required) 1 2 3 4 Brain tumors(Required) 1 2 3 4 Cerebral palsy(Required) 1 2 3 4 Multiple sclerosis(Required) 1 2 3 4 Muscular dystrophy(Required) 1 2 3 4 Polio/post polio syndrome(Required) 1 2 3 4 Spinal cord injury(Required) 1 2 3 4 Adaptive equipment(Required) 1 2 3 4 Functional splinting(Required) 1 2 3 4 Head trauma(Required) 1 2 3 4 Glasgow coma scale(Required) 1 2 3 4 Stroke rehabilitation(Required) 1 2 3 4 Wheelchair prescription(Required) 1 2 3 4 PediatricsActivities of daily living(Required) 1 2 3 4 Developmental disability(Required) 1 2 3 4 Equipment assessment(Required) 1 2 3 4 Individualized education programs(Required) 1 2 3 4 Neurodevelopmental testing (NDT)(Required) 1 2 3 4 Orthotics(Required) 1 2 3 4 Sequencing testing(Required) 1 2 3 4 Sports MedicineBiodex(Required) 1 2 3 4 Bracing/joint(Required) 1 2 3 4 Cybex(Required) 1 2 3 4 Immobilization(Required) 1 2 3 4 Lido(Required) 1 2 3 4 Medical expenses (Norwegian)(Required) 1 2 3 4 Nautilus/eagle(Required) 1 2 3 4 Orthotron/kinetron(Required) 1 2 3 4 Stabilization techniques(Required) 1 2 3 4 Swiss ball(Required) 1 2 3 4 Taping/strapping(Required) 1 2 3 4 Prosthetics/OrthoticsDynamic splints(Required) 1 2 3 4 LE prosthetics(Required) 1 2 3 4 Protonics(Required) 1 2 3 4 Removeable rigid dressings(Required) 1 2 3 4 Serial casting(Required) 1 2 3 4 Static splints(Required) 1 2 3 4 UE prosthetics(Required) 1 2 3 4 ModalitiesAnodyne(Required) 1 2 3 4 Biofeedback(Required) 1 2 3 4 Edema massage(Required) 1 2 3 4 Fluidotherapy(Required) 1 2 3 4 Iontophoresis(Required) 1 2 3 4 JOBST compression pump(Required) 1 2 3 4 Muscle stimulation(Required) 1 2 3 4 Paraffin bath(Required) 1 2 3 4 TENS(Required) 1 2 3 4 Therapeutic pool(Required) 1 2 3 4 Ultrasound(Required) 1 2 3 4 OtherBurn management(Required) 1 2 3 4 Cardiac rehabilitation(Required) 1 2 3 4 Chest physical therapy(Required) 1 2 3 4 DME ordering(Required) 1 2 3 4 FIM scoring(Required) 1 2 3 4 Job task analysis(Required) 1 2 3 4 Lymphedema management(Required) 1 2 3 4 OASIS assessment for home care(Required) 1 2 3 4 Obstetrics in physical therapy(Required) 1 2 3 4 Tone management/spasticity(Required) 1 2 3 4 Wheelchair ordering for SCI patients(Required) 1 2 3 4 Work capacity evaluation(Required) 1 2 3 4 Work hardening(Required) 1 2 3 4 Wound care(Required) 1 2 3 4 Knowledge of payment sources: Medicare(Required) 1 2 3 4 Medicaid(Required) 1 2 3 4 MDS(Required) 1 2 3 4 General SkillsPatient/family teaching(Required) 1 2 3 4 Patients in isolation(Required) 1 2 3 4 Patients in restraints(Required) 1 2 3 4 Initial evaluation(Required) 1 2 3 4 Lift/transfer devices(Required) 1 2 3 4 Specialty beds(Required) 1 2 3 4 End of life care/palliative care(Required) 1 2 3 4 1. Computerized Charting: Cerner(Required) 1 2 3 4 EPIC(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 2. National Patient Safety Goals: Accurate patient identification(Required) 1 2 3 4 Effective communication(Required) 1 2 3 4 Pain assessment & management(Required) 1 2 3 4 Infection control(Required) 1 2 3 4 Universal precautions(Required) 1 2 3 4 Care of patients in isolation(Required) 1 2 3 4 Minimize risk of falls(Required) 1 2 3 4 Prevention of pressure ulcers(Required) 1 2 3 4 Age Specific CompetenciesInfant (birth to 1 year)(Required) 1 2 3 4 Toddler (ages 1-3 years)(Required) 1 2 3 4 Preschooler (ages 3-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 12-21 years)(Required) 1 2 3 4 Young Adults (ages 21-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(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. 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