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PHYSICIANS

ADVANCED PRACTICE

PHARMACY

THERAPY

RADIATION ONCOLOGY

LABORATORY

IMAGING

RESPIRATORY

EMPLOYERS
 
PHYSICIAN ASSISTANT SKILLS CHECKLIST
 
The following checklist is used to assess your experience and skills in order to assist us in placing you in a successful assignment. Please provide an accurate self-assessment of your skills using the following guidelines:
Frequency
Experience
  1. Never Done or Observed Only
  2. Rarely Done (less than 6 times/year)
  3. Occasionally Done (1-2 times/month)
  4. Frequently Done (daily or weekly)
  1. No Experience
  2. Limited Experience
  3. Experienced
  4. Highly Skilled
 
Contact Information      
Name:
Home Phone:
Cell Phone:
Email:
 
Frequency
Experience
Cardiovascular System
1
2
3
4
1
2
3
4
Angina  
Chronic Obstructive Pulmonary Disease  
Congenital Heart Disease  
Congestive Heart Failure  
Coronary Artery Disease  
Functional Murmurs  
Hypertension  
Pericarditis  
Stasis Ulcer of Lower Extremities  
Other:  
                   
Disorders-Emergencies                  
Anaphylaxis  
Animal Bites  
Cardiac Arrest  
Ingestions/Poisonings  
Minor Burns  
Minor Head Injuries  
Open Wounds  
Overdose Sedative/Hypnotics/Opiates  
Seizures  
Shock  
Snake Bites  
                   
Ears, Nose and Throat
1
2
3
4
1
2
3
4
Acute Purulent Otitis Media  
Allergic Rhinitis  
Epistaxis  
Oral Candidiasis  
Otitis Externa  
Pharyngitis  
Serous Otitis Media  
                   
Eye
1
2
3
4
1
2
3
4
Chalazion  
Conjunctivitis  
Strabismus  
Stye  
                   
Endocrine
1
2
3
4
1
2
3
4
Addison’s Disease  
Grave’s Disease  
Hypoglycemia  
Hypothyroidism  
Juvenile Diabetes  
Type I Diabetes Mellitus  
Type II Diabetes Mellitus  
                   
Genitourinary System
1
2
3
4
1
2
3
4
Benign Prostatic Hypertrophy  
Chlamydia  
Cystitis  
Gonococcal Infections  
Herpes  
Hydrocele  
Hypospadias  
Prostatitis  
Pyelonephritis  
Syphilis  
Urinary Tract Infection  
Vulvovaginitis  
                   
GI System
1
2
3
4
1
2
3
4
Acute Gastroenteritis  
Appendicitis  
Cholecystitis  
Colic  
Constipation  
Diarrhea (Simple)  
Duodenal Ulcer  
Hemorrhoids  
Hepatitis  
Hiatal Hernia  
Irritable Bowel Syndrome  
Pyloric Stenosis  
                   
Hematological
1
2
3
4
1
2
3
4
Aplastic Anemia  
Folic Acid Deficiency Anemia  
Iron Deficiency  
Pernicious Anemia  
Sickle Cell Anemia  
                   
Miscellaneous
1
2
3
4
1
2
3
4
Casting/Splinting  
Cell Biopsy  
Starting IV  
Suturing  
                   
Musculoskeletal
1
2
3
4
1
2
3
4
Bursitis  
Carpal Tunnel Syndrome  
Gout  
Juvenile Diabetes  
Minor Sprains/Strains  
Muscular Dystrophy  
Osteoarthritis  
Osteomyelitis  
Osteoporosis  
Rheumatoid Arthritis  
Scoliosis  
Tendonitis  
                   
Nervous System
1
2
3
4
1
2
3
4
Alzeimer’s  
Anxiety  
Bell’s Palsy  
Headaches  
Head Injury  

Migraine

  

Tension

  
Migraine Headaches  
Multiple Sclerosis  
Parkinson’s  
Stroke  
TIA (Transient Ischemic Attacks)  
Trigeminal Neuralgia  
Vasovagal Syncope  
Other:  
                   
OB/GYN
1
2
3
4
1
2
3
4
Atrophic Vaginitis  
Bartholin’s Cyst/Abscess  
Birth Control Methods  
Candida Vaginitis  
Dysfunctional Uterine Bleeding  
Dysmenorrhea  
Fetal Well-Being  
Fibrocystic Breast Disease  
Intrapartum Medications  
Mastitis  
Medications in the Post Partum Phase  
Medications in the Third Stage  
Menopause  
Nausea and Vomiting with Pregnancy  
Pain Relief in Active Phase of Labor  
Pap Smears  

Abnormal Pap Smear Findings

  
Pregnancy/Diagnosis/Referral  
Pre-Natal Care  
Pre-Natal Care  
RH Blood Factor  
Trichomonal Vaginitis  
Other:  
                   
Parasitic Infections
1
2
3
4
1
2
3
4
Ascariasis  
Pediculosis  
Pinworms  
Other  
                   
Psychosocial
1
2
3
4
1
2
3
4
Anorexia  
Anxiety  
Bulimia  
Depression  
Grief  
Obesity  
Suicide  
Other:  
                   
Respiratory
1
2
3
4
1
2
3
4
Asthma  
Bronchitis  
COPD (Chronic Obstructive Pulmonary Disease)  
Croup  
Influenza  
Pneumonia  

Bacterial

  

Viral

  
Sinusitis  

Bacterial

  

Nonbacterial

  
Tracheobronchitis  
URI (Upper Respiratory Infection)  
Other:  
                   
Skin
1
2
3
4
1
2
3
4
Acne  
Basal Skin Carcinoma  
Carbuncles  
Contact Dermatitis  
Diaper Dermatitis  
Folliculitis  
Furuncles  
Herpes Simples  
Herpes Zoster  
Impetigo  
Malignant Melanoma  
Pityriasis Rosea  
Scabies  
Tinea Corporis  
Tinea Pedis  
Warts  
Other:  
                   
Age
1
2
3
4
1
2
3
4
Newborn (birth – 30 days)  
Infant (30 days – 1 year)  
Toddler (1 – 3 years)  
Preschooler (3 – 5 years)  
School Age (5 – 12 years)  
Adolescents (12 – 18 years)  
Young Adults (18 – 39 years)  
Middle Adults (39 – 64 years)  
Older Adults (64+ years)  
                   
Additional Skills, Training, or Equipment                  
 

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Next Medical Staffing to release this Skills Checklist and any supporting information to staffing clients of Next Medical Staffing.
                 

 

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