[checklist name= "Cardiac Monitor Technician (non RNs)" mailto="credentialing@teemagroup.com" templatedoc="17aU7elMuT3ltw9G67rpz28x0PQ1AEC_EPPS0YWSIyyg" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Cardiac Monitor Technician (non RNs)"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Experience In the Following Setting(s)"] [checklistInput type="scale"]Telemetry Unit (located on the unit)[/checklistInput] [checklistInput type="scale"]Remote Telemetry Office[/checklistInput] [checklistInput type="text"]# Monitors Responsible For[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Patient/Equipment Preparation"] [checklistInput type="scale"]Skin prep[/checklistInput] [checklistInput type="scale"]Lead Placement - 3 Lead[/checklistInput] [checklistInput type="scale"]Lead Placement - 5 Lead[/checklistInput] [checklistInput type="scale"]Set up MCL1[/checklistInput] [checklistInput type="scale"]Set up Lead II[/checklistInput] [checklistInput type="scale"]Set up 12 Lead ECG[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Interpret The Following Rhythms"] [checklistInput type="scale"]Normal Sinus Rhythm[/checklistInput] [checklistInput type="scale"]Sinus Bradycardia/Sinus Tachycardia[/checklistInput] [checklistInput type="scale"]Premature Atrial Contractions[/checklistInput] [checklistInput type="scale"]Atrial Flutter[/checklistInput] [checklistInput type="scale"]Atrial Fibrillation[/checklistInput] [checklistInput type="scale"]Junctional Rhythms[/checklistInput] [checklistInput type="scale"]PVC - Unifocal/Multifocal[/checklistInput] [checklistInput type="scale"]PVC- Bigeminy/Trigeminy/Coupling[/checklistInput] [checklistInput type="scale"]Ventricular Tachycardia[/checklistInput] [checklistInput type="scale"]Ventricular Fibrillation[/checklistInput] [checklistInput type="scale"]1st Degree Heart Block[/checklistInput] [checklistInput type="scale"]2nd Degree Heart Block Type I[/checklistInput] [checklistInput type="scale"]2nd Degree Heart Block Type II[/checklistInput] [checklistInput type="scale"]3rd Degree Heart Block[/checklistInput] [checklistInput type="scale"]Sinus Arrest[/checklistInput] [checklistInput type="scale"]Asystole[/checklistInput] [checklistInput type="scale"]Bundle Branch Block[/checklistInput] [checklistInput type="scale"]Paced Rhythms - Atrial/Ventricular/AV[/checklistInput] [checklistInput type="scale"]Pacemaker Misfire[/checklistInput] [checklistInput type="scale"]Pacemaker- Failure to Capture[/checklistInput] [checklistInput type="scale"]Measure Cardiac Rate[/checklistInput] [checklistInput type="scale"]Measure Cardiac Intervals (PR, QRS, ST, etc.)[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Monitoring System Used"] [checklistInput type="scale"]GE[/checklistInput] [checklistInput type="scale"]Philips[/checklistInput] [checklistInput type="scale"]Spacelabs[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Miscellaneous"] [checklistInput type="scale"]Cardiac Arrest Protocol[/checklistInput] [checklistInput type="scale"]Computerized Charting[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Registrations/Certifications"] [checklistInput type="date"]BLS (Exp. Date)[/checklistInput] [checklistInput type="date"]Telemetry Interpretation Course (Date taken)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]