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RADIATION ONCOLOGY

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PHYSICAL THERAPY/PTA 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
General Skills
1
2
3
4
1
2
3
4
Electronic Documentation  
Medicare Documentation  
Patient/Family Education  
Patients in Isolation  
Patients in Restraints  
Written Documentation  
                   
Orthopedics
1
2
3
4
1
2
3
4
Arthritis/Degenerative Joint Disease  
Back Syndromes  
Fibromyalgia  
Hand Injuries  
Hip Fractures/Injuries  
Knee Injuries  
Manual Therapy  
Mobilization Techniques  
Neck Injuries  
Pelvic Fractures/Injuries  
TMJ (Transmandibular Joint Dysfunction)  
Total Joint Replacement/Upper Extremities  
Total Hip/Knee Replacements  
                   
Neurologic
1
2
3
4
1
2
3
4
Adaptive Equipment  
Alzheimer’s Disease  
Cerebral Palsy  
Functional Splinting  
Glasgow Coma Scale  
Guillian-Barre Syndrome  
Head Trauma  
Multiple Sclerosis  
Muscular Dystrophy  
Neurosurgery  
Parkinson’s Disease  
Spinal Cord Injury  
Stroke Rehabilitation  
                   
Pediatrics
1
2
3
4
1
2
3
4
Activities of Daily Living  
Adaptive  
Birth Defects  
Developmental Diseases of Bone  
Developmental Disability Sequencing Testing  
Equipment Assessment  
Fractures  
Neurodevelopmental Deficits  
Neurodevelopmental Techniques  
Neurodevelopmental Testing  
Orthotics  
                   
Sports Medicine
1
2
3
4
1
2
3
4
Athletic Injuries  
Biodex  
Bracing/Joint/Immobilization  
Cybex  
LIDO  
Nautilus/Eagle  
Orthotron  
Recreational Injuries  
Stabilization Techniques  
Strength and Endurance Training  
Taping/Strapping  
                   
Prosthetics/Orthotics
1
2
3
4
1
2
3
4
Above Knee Prosthetics  
Ankle Foot Orthosis  
Below Knee Prosthetics  
Dynamic Splints  
Lower Extremities Prosthetics  
Protonics  
Resting Splints  
Serial/Inhibitory Casting  
Static Splints  
Upper Extremities Prosthetics  
                   
Modalities
1
2
3
4
1
2
3
4
Acuscope  
Biofeedback  
Cryotherapy  
Diathermy  
Edema Massage  
Feeding Techniques  
Fluidotherapy  
Iontophoresis  
JOBST Compression Pump  
Muscle Stimulation  
Paraffin Bath  
TENS  
Therapeutic Pool  
Traction  
Ultrasound  
                   
Other
1
2
3
4
1
2
3
4
Burn Management  
Cardiac Rehabilitation  
Chest Physiotherapy  
Functional Capacity Evaluation  
Geriatrics  
Inservice Education  
Obstetrics in Physical Therapy  
Pulmonary Rehabilitation  
Wheelchair/Equipment Assessment  
Work Capacity Evaluation  
                   
Settings
1
2
3
4
1
2
3
4
General Acute Care  
Adult/ICU  
Children’s Hospital  
Home Health Care  
Pediatrics/PICU  
Private Practice  
Rehabilitation Clinic  
Rehabilitation Hospital  
School System  
Skilled Care Facility  
Outpatient Clinic  
                   
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                  
 
Additional Training                  
 
Additional Tools & 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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