Name:
Email:
LAST 4 OF SSN:
This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
Standard Precautions
Isolation Precautions
Pediatric Respiratory/ Cardiac Arrest
Adult Respiratory/ Cardiac Arrest
Teach Self Breast Exams
Small Facility
Large/Regional Facility
Outpatient
Clinic
Mobile Units
Screening Mammogram
Film Screen
Localizations
Stereotactic Biopsy
Digital Mammography
Needle Localization
Ultrasound Assistance
Biospecimen Radiographs
Xeromammography
Core Biopsies
Magnification View
Spot Compression View
Implants (Eklund View)
Male Mammography
Post Radiation
Special Views
3D/Tomo
Axillary View
Tangential
Rolled
Triangulation
Caudocranial
Lateromedial Oblique
Superolateral to Inferomedial Oblique
Bennett Contour
Bennett MF-150
Fischer Athena
Fischer Mammotest
GE 600T
GE DMR
GE Sinex 600T HF
GE Senoraphe 800T
Giotto HF
Lorad M2E
Lorad ABB
Lorad Elite
Lorad M4
Lorad Transpo 350
Medison ESP-300
Philips Mammo Diagnost
Siemends Mammomat
Transworld Mam CP
Hologic Selenia
Hologic Dimensions
Other
eClinicalworks
EPIC
McKesson
Care 360
Allscripts
Cerner
Optum Insight
NextGen
Greenway
Ambra Health
Sectra
Infinitt
IBM Merge
Philips
FujiFilm
Impax
Centricity
Carestream Vue
Clarity
eRad PACS
Syngo
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64 years to 79 years)
Elderly Adults (over 79+ years)
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
