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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 experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others
 
CLINICAL SETTING
1 2 3 4
 
Acute Care - Adult
 
Acute Care - Pediatric
 
Home Health Care - Adult
 
Home Health Care - Pediatric
 
Long Term Acute Care (LTAC)
 
Outpatient - Adult
 
Outpatient - Pediatric
 
Psychiatric
 
Rehabilitation Facility - Adult
 
Rehabilitation Facility - Pediatric
 
School
 
Skilled Nursing Care
 
Teletherapy: (enter setting)
 
MODALITIES/MANUAL SKILLS/THERAPIES
1 2 3 4
 
Aquatic Therapy
 
Biofeedback
 
Burn/Wound Management
 
Cardiac Rehabilitation
 
Community Re-entry
 
Diathermy
 
Edema Massage
 
Elastic Therapeutic Taping Techniques
 
Electrical Stimulation
 
Feeding/Swallowing
 
Fluidotherapy
 
Handwriting
 
Iontopheresis
 
Joint Mobilization
 
Manual Therapy - Soft Tissue
 
Myofascial Release
 
Paraffin Bath
 
Sensory Integration
 
Substance Abuse
 
TENS
 
Therapeutic Ultrasound
 
Vision Rehabilitation
 
EVALUATION TOOLS - ADULT/PEDIATRIC
1 2 3 4
 
Assessment of Motor and Process Skills (AMPS)
 
Barthel Index and Modified Version
 
Beery-Buktenica Visual-Motor Integration (BEERY VMI)
 
Bruininks-Oseretsky Test of Motor Proficiency (BOT)
 
Canadian Occupational Performance Measure (COPM)
 
Development Test of Visual Perception (DTVP)
 
Disabilities of the Arm, Shoulder and Hand (DASH)
 
Functional Independence Measure (FIM)
 
Functional Reach
 
KATZ Index
 
Kohlman Evaluation of Living Skills (KELS)
 
Motor-Free Visual Perception Test (MVPT-III)
 
Routine Task Inventory (RTI)
 
Sensory Profile
 
Test of Visual Perceptual Skills (TVPS)
 
ADL TRAINING
1 2 3 4
 
Adaptive Equipment
 
Driver's Evaluation/Education
 
Home Assessment
 
Wheelchair Evaluation & Positioning
 
VOCATIONAL TRAINING
1 2 3 4
 
Cognitive Assessment
 
Functional Capacity Evaluation
 
Job Task Analysis
 
Perceptual Assessment
 
Work Hardening
 
ORTHOPEDICS
1 2 3 4
 
Arthritis - Energy Conservation
 
Arthritis - Joint Protection
 
Carpal Tunnel Syndrome
 
Cubital Tunnel Syndrome
 
DeQuervain's Tenosynovitis
 
Fractures of Wrist and Hand
 
Ganglion Cysts
 
Hip Fracture
 
Joint Replacement - Elbow
 
Joint Replacement - Hip/Knee
 
Joint Replacement - Shoulder/Reverse Shoulder
 
Joint Replacement - Wrist/Hand
 
Nerve Entrapment
 
Tendon Transfer Surgery
 
NEUROLOGIC
1 2 3 4
 
ALS
 
Brain Injury
 
CVA
 
Dementia/Alzheimer's
 
Multiple Sclerosis
 
Other Progressive Neurological Disorders
 
Parkinson's Disease
 
Peripheral Nerve Injury
 
SCI
 
PROSTHETIC/ORTHOTICS
1 2 3 4
 
Above/Below Knee Prosthetics
 
Dynamic Splints
 
Static Splints
 
Upper Extremity Prosthetics
 
TECHNOLOGY
1 2 3 4
 
Care Manager
 
Casamba (Smart)
 
Cerner
 
Epic
 
McKesson
 
Meditech
 
Rehab Optima
 
School IEP Documentation Systems:
 
EMR Conversion
 
Other (fill in the blank)
 
Other (fill in the blank)
 
BILLING/DOCUMENTATION
1 2 3 4
 
ICD-10 Coding: Medical Diagnosis
 
ICD-10 Coding: Treatment Diagnosis
 
Medicaid/Medical
 
Medicare Part A
 
Medicare Part B
 
OASIS
 
OT Evaluation Coding
 
Patient Driven Groupings Model (PDGM)
 
Patient Driven Payment Model (PDPM)
 
Section GG
 
PROFESSIONAL KNOWLEDGE AND SKILLS
1 2 3 4
 
Concurrent Therapy
 
Group Therapy
 
Infection Prevention
 
Interdisciplinary Case Management/Case Management
 
Pain Assessment & Management
 
Screening/Adding Caseload
 
Supervisory/Management Experience
 
Age Specific
1 2 3 4
 
Neonate/Infant
 
Toddler/Preschool
 
School Age Children
 
Adolescents
 
Young/Middle Adults
 
Older Adults/Geriatrics
 
CERTIFICATIONS AND QUALIFICATIONS (Current at time of completing this form)
 
BLS
 
Certified Hand Therapist
 
Lymphedema Management
 
Non Violent Crisis Intervention (e.g. CPI)
 
Other: Specify
 
Other: Specify
OT/COTA Skills Checklist, version 9

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. Falsification of any information provided, will result in being ineligible to travel with AMN. 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.

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