Home Health

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Cardiovascular

ACS/Post MI *

Heart Failure *

Post Cardiac Surgery *

Cardiac Auscultation (Rate/Rhythm) *

Peripheral Pulse/Circulation Checks *

Pulmonary

Asthma *

COPD *

Pneumonia *

Lung Cancer *

Pulmonary Emboli *

Auscultate Lung Sounds *

Oxygen Administration *

Oxygen Safety *

Oro/Nasotracheal Suctioning *

CPAP/BiPAP *

Ventilator Management (Specify): *

Neurological

CVA *

Alzheimer's Disease/Dementia *

Parkinson's *

Degenerative Neurologic Disorders (ALS, MS, etc.) *

Brain Tumor *

Brain Injury *

Para/Quadriplegia *

Seizure Disorder *

Level of Consciousness/Neuro Changes *

Orthopedic

Joint Replacement *

DVT Prophylaxis/Recognition *

Incision Checks *

Staple Removal *

Fractures *

Cast/Brace *

Amputation *

Arthritis *

Assistive Equipment/Lift Devices *

In Home PT/INR (Specify): *

Gastrointestinal

Nutritional Assessment *

Colostomy/Ileostomy Management *

Fecal Incontinence/Diarrhea *

Bowel Obstruction *

GI Bleed *

Post GI Surgery *

Hepatitis Liver Failure *

NG Tubes *

Feeding Tubes *

Feeding Pumps (Specify): *

Drainage Devices *

Renal/Genitourinary

Hemodialysis *

AV Fistula/Shunt *

Peritoneal Dialysis *

Post Bladder Surgery *

Post Prostate Surgery *

Urostomy *

Urinary Incontinence *

Bladder Catheter Insertion/Maintenance *

Suprapubic Catheter Insertion/Maintenance *

Endocrine/Metabolic

Diabetes *

Hyper/Hypoglycemia *

Diabetic Skin Assessment *

Cushing's / Addison's Disease *

Thyroid Disease *

Insulin Pumps *

Glucometers *

Wound/Skin Care

Braden Scale *

Pressure Ulcer Prevention *

Pressure Ulcer Staging *

Pressure Ulcer Management *

Burns *

Wound Care *

Wound Cultures *

Wound Vac *

Oncology

Risk for Infection *

Symptom Management *

Side Effects of Treatment *

Terminal Disease *

Infectious Disease

MRSA *

VRE *

C. Difficile *

HIV *

Tuberculosis *

Isolation Precautions *

Phlebotomy/IV Therapy

Peripheral Venipuncture for Labs *

Start IVs *

Peripheral IVs *

PICC/CVP Lines *

Venous Access Ports *

Infusion Pump Set up and Management *

Specify Infusion Pump Type: *

Psychiatric

Cognitive Disorders *

Mood Disorders *

Schizophrenia/Psychotic Disorders *

Medication Compliance *

Women's Health/Maternal-Infant Care

Pregnancy Related Complications *

Fetal Heart Tones *

Contractions *

Post Partum Mother/Baby Visit *

Newborn Care *

Phototherapy *

Breast Feeding Support *

Pediatrics

Growth and Development *

Respiratory Distress Syndrome *

Bronchopulmonary Dysplasia *

Cystic Fibrosis *

Muscular Dystrophy *

Spina Bifida *

Spinal Surgery *

Sickle Cell Disease *

Trach Care/Suctioning *

Ventilator Management *

Ventilator Type (Specify): *

Pain Management

Verbal/Nonverbal Pain Scales *

Response to Pain Management Interventions *

PCA Pump *

Epidural Cath/Site Monitoring/Pump *

Non-Pharmacologic Pain Measures *

Palliative and End of Life Care

Palliative Symptom Management *

Pain Management/Response *

Family Support/Teaching *

After Death Protocols *

Medications

Alzheimer's Medications *

Antiarrhythmics *

Antibiotics/Antivirals *

Anti-Depressants *

Anti-Hypertensives *

Anti-Psychotics *

Anti-Seizure Medications *

Benzodiazepines *

Calculation of Pediatric Dosages *

Coumadin *

Diuretics *

Enoxaparin *

Inhaled Medications *

Nebulizer Medications *

Insulin *

Opioid and Non-Opioid Analgesics *

Oral Chemotherapy *

Oral Hypoglycemics *

Oral & Topics Nitrates *

Rivaroxaban *

Sedative/Hypnotics *

Steroids *

Home Health

Intake/Admissions *

Case Manager *

Case Load - Pts/Day (specify) *

Supervise LVNs/HHAs *

Medicare/Medicaid *

Long/Short Term Disability *

Private Insurance *

Telephonic Assessments *

APS Reports *

OASIS *

Diagnosis Coding *

Document Plan of Care *

Clinical Assessment Documentation *

Professional Knowledge and Skills

National Patient Safety Goals/Core Measures *

Safety Assessment *

Fall Assessment and Prevention *

Patient/Family Teaching *

Age Specific/Population Based Care *

EMR

Allscripts *

Cerner *

Epic *

HomeCare Home Base *

McKesson *

Meditech *

EMR Conversion *

Other Computerized Documentation System *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Epic Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

Home Health

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