Age of Patients Cared ForNewborn to 30 Days* 1 2 3 4 31 Days to 12 Months* 1 2 3 4 13 Months to 5 Years* 1 2 3 4 6 Years to 18 Years* 1 2 3 4 19 Years to 64 Years* 1 2 3 4 65 Years+* 1 2 3 4 General SkillsCare of Patients in Restraints* 1 2 3 4 Lifting/Transferring Devices* 1 2 3 4 Accudose* 1 2 3 4 Promanager Rx* 1 2 3 4 Metro* 1 2 3 4 Pyxis* 1 2 3 4 Omnicell* 1 2 3 4 Allscripts* 1 2 3 4 eCLinicalWorks* 1 2 3 4 McKesson* 1 2 3 4 Soarian* 1 2 3 4 Care360* 1 2 3 4 EPIC* 1 2 3 4 Meditech* 1 2 3 4 Cerner* 1 2 3 4 MACLAB* 1 2 3 4 PACS* 1 2 3 4 Alaris* 1 2 3 4 Baxter* 1 2 3 4 IVAC* 1 2 3 4 Alibaba* 1 2 3 4 Braun* 1 2 3 4 Zynomed* 1 2 3 4 Bard* 1 2 3 4 CADD* 1 2 3 4 Knowledge of "Do Not Use Abbreviations"* 1 2 3 4 Do you have charge/supervisor experience?* 1 2 3 4 Knowledge of current Joint Commission National Patient Safety Goals* 1 2 3 4 Knowledge/familiarity with HCAHPS scores* 1 2 3 4 PRE-PROCEDUREAllen Test* 1 2 3 4 Doppler* 1 2 3 4 EKG lead/pad placement* 1 2 3 4 Blood Pressure Invasive and Noninvasive* 1 2 3 4 HEMODYNAMIC MONITORINGMonitoring/Recording cases* 1 2 3 4 Coagulation Interpretation* 1 2 3 4 Waveform Assessment* 1 2 3 4 CARDIOVASCULARHematoma Recognition/Management* 1 2 3 4 Radial, brachial, femoral, pedal pulse checks* 1 2 3 4 PULMONARYSet up Oxygen Delivery Devices(Cannula, NRBM, Ambu)* 1 2 3 4 Assist with Intubation* 1 2 3 4 Suction equipment (oral,NP, In line)* 1 2 3 4 PROCEDURES DIAGNOSTIC AND INTERVENTIONALPanning Table* 1 2 3 4 Moving Image Intensifier, Knowledge of views( RAO, LAO, cranial, caudal)* 1 2 3 4 Scrub Diagnostic Procedures* 1 2 3 4 Scrub Interventional Procedures* 1 2 3 4 Specimen Radiographs* 1 2 3 4 Selective Radiographs* 1 2 3 4 TIPPS Procedure* 1 2 3 4 Angioplasty/Stent* 1 2 3 4 Thrombolysis/Thrombectomy* 1 2 3 4 Embolic Protection Devices* 1 2 3 4 Cerebral Coiling* 1 2 3 4 PVA* 1 2 3 4 Gelfoam* 1 2 3 4 Cerebral Angiography* 1 2 3 4 Carotid Arteriogram* 1 2 3 4 Brachial Arteriogram* 1 2 3 4 Aortogram* 1 2 3 4 Femoral Arteriogram* 1 2 3 4 Renal Arteriogram* 1 2 3 4 Pulmonary Arteriogram* 1 2 3 4 Venogram* 1 2 3 4 Endografts* 1 2 3 4 AV Fistulas* 1 2 3 4 PACEMAKERSPermanent Pacemaker/AICD* 1 2 3 4 Temporary Epicardial/Transthoracic Pacing* 1 2 3 4 Temporary External /transvenous pacing* 1 2 3 4 CARE OF PATIENT DURING EMERGENCY PROCEDURESEmergency Defibrillation/ Cardioversion* 1 2 3 4 Anaphylaxis* 1 2 3 4 Vasovagal Response* 1 2 3 4 Pneumothorax* 1 2 3 4 Cardiogenic Shock* 1 2 3 4 Embolism* 1 2 3 4 Cardiac/Respiratory arrest* 1 2 3 4 EQUIPMENT/SUPPLIESACT Machine* 1 2 3 4 Hemochron* 1 2 3 4 Power Injectors* 1 2 3 4 Manual Pressure Hold* 1 2 3 4 Femostop/ C-Clamp* 1 2 3 4 VasoSeal, Angioseal, PerClose* 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