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Skills Checklists

Congratulations on your decision to apply for an allied position with ClubStaffing! Before we can offer you an allied employment opportunity, an electronic skills assessment must be completed. From the skills checklist below, please locate the list that matches your specialty and complete the online form. Be sure to review your information thoroughly before clicking the submit button. Thank you!

ClubStaffing
5901 Broken Sound Pkwy.
Suite 450
Boca Raton, Florida 33487
Fax: (561) 367-0884


OT/COTA Skills Checklist

*
Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
Last 4 of Social Security Number*
- -
E-Mail Address* Phone Number*
or
 
 
Please mark your level of experience
1. No theory and/or experience
2. Limited experience/need supervision and/or support
3. Experienced/minimal support needed to perform
4. Proficient/can perform independently
 
CLINICAL SETTING
1 2 3 4
 
Acute Care - Adult
 
Acute Care - Pediatric
 
Rehabilitation Facility - Adult
 
Rehabilitation Facility - Pediatric
 
Outpatient - Adult
 
Outpatient - Pediatric
 
Home Health Care - Adult
 
Home Health Care - Pediatric
 
Skilled Nursing Care
 
Long Term Acute Care (LTAC)
 
School
 
Psychiatric
 
Teletherapy: (enter setting)
 
MODALITIES/MANUAL SKILLS/THERAPIES
1 2 3 4
 
Feeding/Swallowing
 
Sensory Integration
 
Handwriting
 
Edema Massage
 
Joint Mobilization
 
Manual Therapy - Soft Tissue
 
Elastic Therapeutic Taping Techniques
 
Aquatic Therapy
 
Fluidotherapy
 
Paraffin Bath
 
Therapeutic Ultrasound
 
Diathermy
 
Myofascial Release
 
Electrical Stimulation
 
Biofeedback
 
Iontopheresis
 
TENS
 
Burn/Wound Management
 
Cardiac Rehabilitation
 
Vision Rehabilitation
 
Substance Abuse
 
Community Re-entry
 
EVALUATION TOOLS - ADULT/PEDIATRIC
1 2 3 4
 
Kohlman Evaluation of Living Skills (KELS)
 
Disabilities of the Arm, Shoulder and Hand (DASH)
 
Functional Reach
 
KATZ Index
 
Barthel Index and Modified Version
 
Canadian Occupational Performance Measure (COPM)
 
Routine Task Inventory (RTI)
 
Functional Independence Measure (FIM)
 
Assessment of Motor and Process Skills (AMPS)
 
Motor-Free Visual Perception Test (MVPT-III)
 
Sensory Profile
 
Beery-Buktenica Visual-Motor Integration (BEERY VMI)
 
Bruininks-Oseretsky Test of Motor Proficiency (BOT)
 
Test of Visual Perceptual Skills (TVPS)
 
Development Test of Visual Perception (DTVP)
 
ADL TRAINING
1 2 3 4
 
Adaptive Equipment
 
Home Assessment
 
Wheelchair Evaluation & Positioning
 
Driver's Evaluation/Education
 
VOCATIONAL TRAINING
1 2 3 4
 
Functional Capacity Evaluation
 
Perceptual Assessment
 
Cognitive Assessment
 
Job Task Analysis
 
Work Hardening
 
ORTHOPEDICS
1 2 3 4
 
Carpal Tunnel Syndrome
 
Cubital Tunnel Syndrome
 
Ganglion Cysts
 
Fractures of Wrist and Hand
 
Tendon Transfer Surgery
 
DeQuervain's Tenosynovitis
 
Nerve Entrapment
 
Joint Replacement - Wrist/Hand
 
Joint Replacement - Shoulder/Reverse Shoulder
 
Joint Replacement - Elbow
 
Joint Replacement - Hip/Knee
 
Hip Fracture
 
Arthritis - Energy Conservation
 
Arthritis - Joint Protection
 
NEUROLOGIC
1 2 3 4
 
Brain Injury
 
SCI
 
CVA
 
Peripheral Nerve Injury
 
Parkinson's Disease
 
Dementia/Alzheimer's
 
Multiple Sclerosis
 
ALS
 
Other Progressive Neurological Disorders
 
PROSTHETIC/ORTHOTICS
1 2 3 4
 
Above/Below Knee Prosthetics
 
Upper Extremity Prosthetics
 
Static Splints
 
Dynamic Splints
 
TECHNOLOGY
1 2 3 4
 
Casamba (Smart)
 
Care Manager
 
Cerner
 
Epic
 
McKesson
 
Meditech
 
Rehab Optima
 
School IEP Documentation Systems:
 
Other (fill in the blank)
 
Other (fill in the blank)
 
EMR Conversion
 
BILLING/DOCUMENTATION
1 2 3 4
 
Patient Driven Groupings Model (PDGM)
 
Patient Driven Payment Model (PDPM)
 
Medicare Part A
 
Medicare Part B
 
Medicaid/Medical
 
OASIS
 
Section GG
 
ICD-10 Coding: Medical Diagnosis
 
ICD-10 Coding: Treatment Diagnosis
 
OT Evaluation Coding
 
PROFESSIONAL KNOWLEDGE AND SKILLS
1 2 3 4
 
Supervisory/Management Experience
 
Screening/Adding Caseload
 
Infection Prevention
 
Pain Assessment & Management
 
Group Therapy
 
Concurrent Therapy
 
Interdisciplinary Case Management/Case Management
 
Age Specific
1 2 3 4
 
Neonate/Infant
 
Toddler/Preschool
 
School Age Children
 
Adolescents
 
Young/Middle Adults
 
Older Adults/Geriatrics
 
CERTIFICATIONS AND QUALIFICATIONS
 
Certified Hand Therapist
 
Lymphedema Management
 
Non Violent Crisis Intervention (e.g. CPI)
 
BLS
 
Other: Specify
 
Other: Specify
OT/COTA Skills Checklist, version 8

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 authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

© 2018 AMN Healthcare, Inc. All rights reserved. Reproduction and distribution of these materials is prohibited without the expressed written authorization of AMN Healthcare, Inc.