Vascular Interventional Technologist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreName(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 independentlyGENERAL SKILLS EXPERIENCEAdvanced directives(Required) 1 2 3 4 Supervisory or Charge experience(Required) 1 2 3 4 National Patient Safety Goals/Core Measures(Required) 1 2 3 4 Awareness of HCAHPS(Required) 1 2 3 4 Accurate Patient Identification(Required) 1 2 3 4 Maintain Sterile Field(Required) 1 2 3 4 Use proper body mechanics(Required) 1 2 3 4 Use of transfer/lifting Devices(Required) 1 2 3 4 Infection Control(Required) 1 2 3 4 Universal Precautions(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Minimize fall risks(Required) 1 2 3 4 Crash Cart(Required) 1 2 3 4 Defibrillator(Required) 1 2 3 4 Care of patient in Restraints(Required) 1 2 3 4 Obtain Vital Signs(Required) 1 2 3 4 Patient /Family education(Required) 1 2 3 4 Electronic Documentation(Required) 1 2 3 4 Ensures HIPAA compliance(Required) 1 2 3 4 Quality control of equipment(Required) 1 2 3 4 Diagnostic Criteria Quality(Required) 1 2 3 4 Image annotation(Required) 1 2 3 4 Flow Studies(Required) 1 2 3 4 Transducer Selection(Required) 1 2 3 4 Disinfection of equipment(Required) 1 2 3 4 Photoplethysmography(Required) 1 2 3 4 IV SKILLSIV insertion(Required) 1 2 3 4 Maintenance of IV(Required) 1 2 3 4 Use of contrast agents(Required) 1 2 3 4 VASCULAR PROCEDURESCarotid Artery(Required) 1 2 3 4 Subclavian artery(Required) 1 2 3 4 Vertebral artery(Required) 1 2 3 4 Arterial peripheral upper extremity(Required) 1 2 3 4 Arterial peripheral lower extremity(Required) 1 2 3 4 Arterial Graft Duplex(Required) 1 2 3 4 Venous peripheral upper extremity(Required) 1 2 3 4 Venous peripheral lower extremity(Required) 1 2 3 4 Duplex(Required) 1 2 3 4 Color Doppler(Required) 1 2 3 4 Carotid Doppler(Required) 1 2 3 4 ECHOCARDIOGRAPHYEKG(Required) 1 2 3 4 TEE (transesophageal esophagography)(Required) 1 2 3 4 Adult echocardiogram(Required) 1 2 3 4 Pediatric echocardiogram(Required) 1 2 3 4 Stress Echo(Required) 1 2 3 4 Doppler(Required) 1 2 3 4 Dobutamine stress echocardiogram(Required) 1 2 3 4 Color Flow(Required) 1 2 3 4 M Mode(Required) 1 2 3 4 Real Time(Required) 1 2 3 4 DOCUMENTATIONAllscripts(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Epic(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 PACS(Required) 1 2 3 4 WORK SETTINGAcute Hospital Setting(Required) 1 2 3 4 Large/Regional Teaching Facility(Required) 1 2 3 4 Outpatient Clinic(Required) 1 2 3 4 CERTIFICATIONS/LICENSURE/REGISTRATIONSBLS(Required) 1 2 3 4 ACLS(Required) 1 2 3 4 PALS(Required) 1 2 3 4 ARRT(Required) 1 2 3 4 IR PROCEDURES (PREPARE)Cerebral Angiogram(Required) 1 2 3 4 Lower Extremity Angiogram(Required) 1 2 3 4 Upper Extremity Angiogram(Required) 1 2 3 4 Ultrasound Guided Biopsy(Required) 1 2 3 4 CT Scan Guided Biopsy(Required) 1 2 3 4 Liver Biopsy & Embolization(Required) 1 2 3 4 Line Placement - Broviac(Required) 1 2 3 4 Line Placement - Groshong(Required) 1 2 3 4 Line Placement - Hickman(Required) 1 2 3 4 Line Placement - PICC(Required) 1 2 3 4 Line Placement - PortaCath(Required) 1 2 3 4 Uterine Fibroid Embolization(Required) 1 2 3 4 Temp Hemodialysis Shunt Placement(Required) 1 2 3 4 Perm Hemodialysis Shunt Placement(Required) 1 2 3 4 AV Fistula/Shunt Declotting(Required) 1 2 3 4 Vertebroplasty(Required) 1 2 3 4 Lumbar Puncture(Required) 1 2 3 4 Myelogram(Required) 1 2 3 4 IR PROCEDURES (ASSIST)Cerebral Angiogram(Required) 1 2 3 4 Lower Extremity Angiogram(Required) 1 2 3 4 Upper Extremity Angiogram(Required) 1 2 3 4 CT Scan Guided Biopsy(Required) 1 2 3 4 Liver Biopsy & Embolization(Required) 1 2 3 4 Line Placement - Broviac(Required) 1 2 3 4 Line Placement - Groshong(Required) 1 2 3 4 Line Placement - Hickman(Required) 1 2 3 4 Line Placement - PICC(Required) 1 2 3 4 Line Placement - PortaCath(Required) 1 2 3 4 Uterine Fibroid Embolization(Required) 1 2 3 4 Temp Hemodialysis Shunt Placement(Required) 1 2 3 4 Perm Hemodialysis Shunt Placement(Required) 1 2 3 4 AV Fistula/Shunt Declotting(Required) 1 2 3 4 Vertebroplasty(Required) 1 2 3 4 Lumbar Puncture(Required) 1 2 3 4 Myelogram(Required) 1 2 3 4 Ultrasound Guided Biopsy(Required) 1 2 3 4 AGE-SPECIFIC EXPERIENCENewborn / neonate (birth-30 days)(Required) 1 2 3 4 Infant (31 days-1 year)(Required) 1 2 3 4 Toddler (ages 2-3 years)(Required) 1 2 3 4 Preschool (ages 4-5 years)(Required) 1 2 3 4 School age (ages 6-12 years)(Required) 1 2 3 4 Adolescent (ages 13-21 years)(Required) 1 2 3 4 Young adult (ages 22-39 years)(Required) 1 2 3 4 Adult (ages 40-64 years)(Required) 1 2 3 4 Older adult (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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