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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


EEG Technologist 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*
E-Mail Address* Phone Number*
 
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
 
WORK SETTING
1 2 3 4
 
Hospital
 
Outpatient
 
EEG PERFORMED
1 2 3 4
 
10-20 Electrode Placement
 
Portable Recording in Adult ICU
 
Portable Recording in Pediatric ICU
 
Portable Recording in NICU
 
ECI-Brain Death Recording
 
Ambulatory EEG
 
Sleep Deprived EEG
 
Sleep EEG
 
Evoked Potentials
1 2 3 4
 
Assist with Nerve Conduction Studies/Electromyography
 
Auditory Evoked Potential
 
Motor Evoked Potential (OR)
 
Somatosensory Evoked Potentials (SSEP)
 
Visual Evoked Potential
 
EQUIPMENT
1 2 3 4
 
Biologic
 
Cadwell
 
Grass
 
Nicolet
 
Nihon Koden
 
Xltek
 
Other: Specify
 
PROFESSIONAL KNOWLEDGE AND SKILLS
1 2 3 4
 
Changes in Patient Status
 
Hyperventilation
 
Interpreting EEG Patterns
 
Post Hyperventilation
 
Stimulation
 
AGE SPECIFIC/POPULATION-BASED CARE
1 2 3 4
 
Neonate/Infant
 
Toddler/Preschool
 
School Age
 
Adolescents
 
Young/Middle Adults
 
Older Adults/Geriatrics
 
EMR
1 2 3 4
 
Allscripts
 
GE
 
Bar Coding for Medication Administration
 
Cerner
 
Computer Physician Order Entry
 
Eclipsys
 
Epic
 
McKesson
 
Meditech
 
Other: Specify
 
Other: Specify
 
EMR Conversion
 
CERTIFICATIONS(Current at the time of completing this form)
 
BLS
 
EEG Credential (ABRET)
 
CNIM
 
EP
 
Registered EEG Tech
 
Other: Specify
EEG Technologist Skills Checklist, version 5

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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