= Skills Checklist =

Long Term Care Skills

Please rank the following skills on a scale of 1 to 4

1 = No theory and/or experience
2 = Limited experience
3 = Experienced/minimal support needed to perform
4 = Proficient

  • Experience with the Following Ages

  • General Skills

  • Medication – Knowledge and Use of

  • Phlebotomy/IV Therapy

  • Cardiac General Skills and Care of Patient

  • Care of Patient With

  • Respiratory General Skills and Care of Patient:

  • Knowledge and Use of

  • Neuro General Skills and care of patients:

  • Knowledge and Use of

  • Sensory Deficits – Care of Patients with

  • Gastrointestianl – Care of Patients With

  • GI General

  • Knowledge and Use of

  • Renal/GU – care of Paitients with

  • Peritoneal Dialysis

  • Orthopedic Care of Patients with

  • Orthopedic General

  • Wound Care

  • Additional Skills

  • MM slash DD slash YYYY