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Proficiency Scale
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No Experience
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Need Training
3 =
Able to perform with supervision
4 =
Able to perform independently
Assessment Section
Areas Worked
✔ Emergency
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✔ Urgent Care
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✔ Private Practice
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✔ HMO
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✔ MD Office
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✔ Schools
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✔ Health Department
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✔ Ambulatory Clinic
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✔ Rural Health Clinic
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✔ Psychiatric Facility
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✔ Correctional Facility
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✔ Mobile Medical Unit
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✔ Corporate Worksite
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✔ Occupational Health
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✔ Rehabilitation
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✔ Nursing Home/ Long-term Care Facility
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✔ Women's Health Clinic
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✔ Government Health Agency
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✔ Hospice/Palliative Care
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Experience With
✔ Diabetes
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✔ Contractures
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✔ Bedridden residents
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✔ Splinting of extremities
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✔ Local infiltration
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✔ Comprehensive physical assessment
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✔ Acute disease condition
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✔ Differential diagnosis
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✔ Order, may perform, & interpret screening & diagnostic test
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✔ Central line management
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Disorders Emergencies
✔ Anaphylaxis
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✔ Cardiac arrest
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✔ Seizures
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✔ Minor head injuries
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✔ Animal bites
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✔ Ingestions and poisonings
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✔ Overdose of sedative, hypnotics, opiates
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✔ Snake bites
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✔ Minor burns
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✔ Shock
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✔ Open wounds
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Collaboration
✔ Family, support system, community resources
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✔ Consulting with Physicians
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✔ Consulting with Pharmacists
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✔ Consulting with Speech Therapist
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✔ Consulting with Dietician and Diet Aide
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✔ Consulting with Occupational Therapist
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✔ Referral to Pastoral Services
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Respiratory
✔ Croup
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✔ Influenza
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✔ Tracheobronchitis
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✔ Bronchitis
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✔ COPD (chronic obstructive pulmonary disease)
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✔ Asthma
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✔ URI (upper respiratory infection)
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✔ Obstructive Sleep Apnea
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✔ Viral
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✔ Bacterial (1)
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✔ Bacterial (2)
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✔ Nonbacteria
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✔ Oxygen administration
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✔ Liquid oxygen
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✔ IPPB machine use
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✔ Tracheotomies
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✔ Interpret ABG (blood gases)
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✔ Intubations
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✔ Sputum Collection
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Cardiovascular System
✔ Congestive heart failure
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✔ Chronic obstructive pulmonary disease
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✔ Stasis ulcer of lower extremities
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✔ Angina
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✔ Post Thoracic Surgery
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✔ Coronary artery disease
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✔ Functional murmurs
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✔ Congenital heart disease
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✔ Hypertension
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✔ ASHD (arteriosclerotic heart disease)
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✔ Dyslipidemia
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✔ PVD (peripheral vascular disease)
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✔ Peripheral neuropathy
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✔ Interpreting 12 lead EKG's
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OB/GYN
✔ Candida vaginitis
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✔ Dysmenorrhea
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✔ Abnormal pap smear findings
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✔ Pap smears
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✔ Trichomonal vaginitis
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✔ Atrophic vaginitis
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✔ Fibrocystic breast disease
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✔ Menopause
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✔ Intrapartum medications
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✔ Bartholin's cyst/abscess
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✔ Preparation for childbirth
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✔ Pregnancy - diagnosis and referral
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✔ Medications in the third stage
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✔ Dysfunctional uterine bleeding
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✔ Medications in the postpartum phase
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✔ Rh blood factor
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✔ Mastitis
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✔ Birth control methods
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✔ Prenatal care
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✔ Fetal well-being
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✔ Nausea and vomiting with pregnancy
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✔ Pregnancy test kits
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GI System
✔ Constipation
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✔ Diarrhea (simple)
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✔ Acute gastroenteritis
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✔ Cholecystitis
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✔ Pyloric stenosis
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✔ Colic
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✔ Appendicitis
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✔ Naso-gastric tubes
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✔ Gastrostomy Care
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Skin
✔ Warts
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✔ Basal cell carcinoma
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✔ Scabies
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✔ Impetigo
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✔ Diaper dermatitis
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✔ Acne
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✔ Folliculitis
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✔ Furuncles
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✔ Carbuncles
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✔ Herpes Simplex
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✔ Herpes Zoster
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✔ Malignant melanoma
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✔ Pityriasis Rosea
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✔ Contact dermatitis
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✔ Tinea corporis
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✔ Staph infections
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✔ Wound care
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✔ Single layer wound closure
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✔ Incision and drainage
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✔ Excisions
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Ears, Nose and Throat
✔ Epistaxis
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✔ Otitis externa
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✔ Serous otitis media
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✔ Acute purulent otitis media
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✔ Pharyngitis
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✔ Oral candidiasis
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Eye
✔ Conjunctivitis
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✔ Strabismus
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✔ Chalazion
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✔ Stye
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✔ Visual acuity
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✔ Fluorescein staining of eyes
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✔ Audiometry
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✔ Tympanometry
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Musculoskeletal
✔ Osteoporosis
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✔ Osteomyelitis
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✔ Rheumatoid arthritis
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✔ Juvenile diabetes
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✔ Gout
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✔ Minor sprains and strains
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✔ Osteoarthritis
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✔ Carpal tunnel syndrome
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✔ Scoliosis
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✔ Tendonitis
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✔ Bursitis
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✔ Muscular dystrophy
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Parasitic Infections
✔ Pinworms
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✔ Ascariasis
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✔ Pediculosis
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Genitourinary System
✔ philis
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✔ Chlamydia
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✔ Herpes
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✔ Cystitis
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✔ Pyelonephritis
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✔ Urinary tract infection
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✔ Benign prostatic hypertrophy
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✔ Vulvovaginitis
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✔ Hydrocele
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✔ Gonococcal infections
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✔ Prostatitis
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✔ Catheter Care
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✔ Incontinence care-bowel
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✔ Dermal ulcers
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✔ Urine collection
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Nervous System
✔ Vasovagal syncope
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✔ Migraine headaches
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✔ Multiple sclerosis
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✔ Headaches
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✔ Head injury
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✔ Tension
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✔ Anxiety
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✔ Parkinson's
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✔ zheimer's
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✔ Bell's Palsy
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✔ TIA (transient ischemic attacks)
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✔ Trigeminal neuralgia
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Endocrine
✔ Type I diabetes mellitus
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✔ Type II diabetes mellitus
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✔ Graves disease
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✔ Addison's disease
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✔ Juvenile diabetes
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✔ Hypoglycemia
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✔ Hypothyroidism
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Hematological
✔ Folic acid deficiency anemia
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✔ Aplastic anemia
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✔ Iron deficiency
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✔ Sickle cell anemia
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✔ Pernicious anemia
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✔ Hemoglobinmeter
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Psychosocial
✔ Depression
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✔ Suicide
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✔ Obesity
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✔ Grief
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✔ Anxiety
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✔ Anorexia
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✔ Bulimia
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Drug Therapy
✔ Prescription
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✔ Over the counter (OTC)
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✔ Herbal drugs
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✔ Knowledge of pharmacology
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✔ Knowledge of pharmacokinetics
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✔ Knowledge of drug interactions
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✔ Knowledge of side effects
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✔ Allergic reactions
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✔ Anaphylaxis reaction
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✔ TPN/Lipid Management
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✔ Management/Titration of IV Therapies
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✔ IV/PO Antibiotic Therapy and understanding of cultures
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Dispensing Medication
✔ Monitoring drug therapy
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✔ Management of controlled substances
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✔ Injections
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Non-Pharmacologic Interventions
✔ Medical nutrition therapy
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✔ Exercise
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✔ Cessation of substance abuse (alcohol, tobacco)
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✔ Mental health issues (stress management, depression)
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✔ Obesity management
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✔ Tube Feeding Management
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Miscellaneous
✔ Public health and health promotion
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✔ Research
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✔ Quality assurance
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✔ Leadership and teaching skills
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✔ Legal and ethical issues
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✔ Confidentiality
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✔ Cultural awareness
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✔ Self evaluation to improve patient care
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✔ ntinuing education
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✔ Working within scope of practice
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✔ Discharge planning / collaboration
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✔ Suturing
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✔ Cell biopsy
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✔ Starting IV
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✔ Casting and splinting
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✔ Radiographic interpretation (initial)
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✔ Informed consent
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✔ Explanation to patient/family
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✔ Documentation
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✔ Ultrasounds
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✔ Venipuncture
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Programs
✔ OSHA (Occupational Safety and Health Administration)
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✔ Medicare and Medicaid
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✔ CLIA waiver (Clinical Laboratory Improvement Amendments)
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✔ TJC (The Joint Commission)
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✔ HEDIS (Health Plan Employer Data and Information Set)
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✔ DQIP (Diabetes Quality Improvement Program)
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✔ HIPAA (Health Insurance Portability & Accountability Act)
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✔ HCAHPS
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Age Specific Competencies
✔ Newborn/neonate (birth-30 days)
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✔ Infant (31 days-1 year)
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✔ Toddler (ages 2-3 years)
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✔ Preschool (ages 4-5 years)
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✔ School age (ages 6-12 years)
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✔ Young adult (ages 22-39 years)
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✔ Adults (ages 40-64 years)
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✔ Elderly (ages 80+ years)
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✔ Older adult (ages 65-79 years)
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