Age of Patients Cared ForNewborn/Neonate (Birth to 30 days)* 1 2 3 4 Infant (1 month to 1 year)* 1 2 3 4 Toddler (1 year to 3 years)* 1 2 3 4 Preschooler (3 years to 5 years)* 1 2 3 4 School Age (5 years to 12 years)* 1 2 3 4 Adolescents (12 years to 18 years)* 1 2 3 4 Young Adults (18 years to 39 years)* 1 2 3 4 Middle Adults (39 years to 64 years)* 1 2 3 4 Older Adults (64 years to 79 years)* 1 2 3 4 Elderly Adults (79 years and up)* 1 2 3 4 SkillsTaking and Recording Ht. And Wt.* 1 2 3 4 Recording of History* 1 2 3 4 Blood Pressure* 1 2 3 4 TPR* 1 2 3 4 Recording Vital Signs* 1 2 3 4 Blood collection by venipuncture/phlebotomy* 1 2 3 4 Blood collection by capillary stick* 1 2 3 4 Knowledge of colors of test tube* 1 2 3 4 Urine collection/urinalysis* 1 2 3 4 Specimen handling and labeling* 1 2 3 4 Ability to perform EKG* 1 2 3 4 Injection:* 1 2 3 4 Intramuscular* 1 2 3 4 Subcutaneous* 1 2 3 4 Intradermal* 1 2 3 4 Wound dressing and changing* 1 2 3 4 Sterile technique* 1 2 3 4 Assisting in biopsies* 1 2 3 4 Assisting in suture or staple removal* 1 2 3 4 Knowledge of Universal Precaution* 1 2 3 4 Assisting in telephone triage* 1 2 3 4 Assisting in clerical duty* 1 2 3 4 Physician PracticeCosmetic Surgery* 1 2 3 4 Dermatology* 1 2 3 4 Family practice* 1 2 3 4 Internal medicine* 1 2 3 4 Geriatrics* 1 2 3 4 OB-GYN* 1 2 3 4 Oncology* 1 2 3 4 Ophthalmology/Optometrist* 1 2 3 4 Orthopedic* 1 2 3 4 Pediatrics* 1 2 3 4 Psychiatry* 1 2 3 4 Urology* 1 2 3 4 Please list the EMR systems you have used** I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.** I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
