SettingAcute* 1 2 3 4 Rehab* 1 2 3 4 Inpatient* 1 2 3 4 Outpatient* 1 2 3 4 Home Health* 1 2 3 4 SNF* 1 2 3 4 Schools* 1 2 3 4 Adaptive EquipmentAssessments* 1 2 3 4 Augmentative Communication* 1 2 3 4 Computer-based Treatment/Adaptive Microswitches* 1 2 3 4 Speech / Language / Hearing DisabilitiesFeeding Disorders* 1 2 3 4 Cleft Palate* 1 2 3 4 Cognitive Rehab* 1 2 3 4 Coma Stimulation* 1 2 3 4 CVA / Stroke Rehab* 1 2 3 4 Dysphagia* 1 2 3 4 Fluency / Stuttering* 1 2 3 4 Head Injury* 1 2 3 4 Hearing Impaired* 1 2 3 4 Laryngectomy* 1 2 3 4 Neurological* 1 2 3 4 Voice* 1 2 3 4 PediatricsCerebral Palsy* 1 2 3 4 Early Intervention* 1 2 3 4 Learning Language Disabilities* 1 2 3 4 Intellectual/Developmental Disabilities* 1 2 3 4 NDT for Speech* 1 2 3 4 Other SkillsAccent Reduction* 1 2 3 4 Aural Rehabilitation / Speech Reading* 1 2 3 4 Biofeedback-EMG* 1 2 3 4 Cognitive Assessment* 1 2 3 4 Co-Treatment with OT* 1 2 3 4 Co-Treatment with PT* 1 2 3 4 Family Education* 1 2 3 4 Group Activities* 1 2 3 4 In-service Education* 1 2 3 4 Myofunctional Therapies* 1 2 3 4 Prosthetics- Cleft Palate* 1 2 3 4 Rehab Feeding Group* 1 2 3 4 Sign Language* 1 2 3 4 Tracheostomy* 1 2 3 4 Ventilator* 1 2 3 4 Videofluoroscopy* 1 2 3 4 FEEST* 1 2 3 4 Electronic Documentation* 1 2 3 4 List Types:Electronic Documentation* 1 2 3 4 List Types:Electronic Documentation* 1 2 3 4 List Types:AgeNewborn (birth-30 days)* 1 2 3 4 Infant (30 days - 1 year)* 1 2 3 4 Toddler (1 - 3 years)* 1 2 3 4 Preschooler (3 - 5 years)* 1 2 3 4 School Age (5 - 12 years)* 1 2 3 4 Adolescents (12 - 18 years)* 1 2 3 4 Young Adults (18 - 39 years)* 1 2 3 4 Middle Adults (39 - 64 years)* 1 2 3 4 Older Adults (64+ years)* 1 2 3 4 * 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*Date* MM slash DD slash YYYY
