Cytotechnologist

Gyn

Screen: #/day*

1
2
3
4

Review: #/day*

1
2
3
4

Non-Gyn

Ascitic Fluid*

1
2
3
4

Bronchial*

1
2
3
4

Esophageal*

1
2
3
4

Gastric*

1
2
3
4

Spinal*

1
2
3
4

Urine*

1
2
3
4

Other (List)

Other (Rate)

1
2
3
4

ThinPrep

Gyn*

1
2
3
4

Non-Gyn*

1
2
3
4

Fixations

Saccomanno*

1
2
3
4

Cytolyt*

1
2
3
4

Carbowax*

1
2
3
4

95% Alcohol*

1
2
3
4

Filter Prep*

1
2
3
4

Fine Needle Aspirations

Assist*

1
2
3
4

Make Smears*

1
2
3
4

Collection*

1
2
3
4

Preliminary Diagnosis*

1
2
3
4

Onsite Procedures*

1
2
3
4

Staining*

1
2
3
4

Special Stains/Organisms

GMS*

1
2
3
4

PAP*

1
2
3
4

IRON*

1
2
3
4

Other (List)

Other (Rate)

1
2
3
4

Other Skills

Flow Cytometry*

1
2
3
4

DNA Ploidy*

1
2
3
4

FISH*

1
2
3
4

Classification System Used*

Instrumentation*

ALab Computer Systems (LIS) Used*

Electronic Documentation

List Types

Other

Application Agreement

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*

Title