[checklist name= "MED SURG" mailto="credentialing@teemagroup.com" templatedoc="18CM4TjWsL8QeSh5ZX63lYUhbXM58DPloCkDh48lKLUs" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="MED SURG"] 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="CARDIAC"] [checklistInput type="scale"]Angina[/checklistInput] [checklistInput type="scale"]Post Acute MI[/checklistInput] [checklistInput type="scale"]Congestive Heart Failure[/checklistInput] [checklistInput type="scale"]Post Cardiac Cath[/checklistInput] [checklistInput type="scale"]Post Cardiac Surgery[/checklistInput] [checklistInput type="scale"]Aneurysm[/checklistInput] [checklistInput type="scale"]Carotid Endarterectomy[/checklistInput] [checklistInput type="scale"]Post Vascular Surgery[/checklistInput] [checklistInput type="scale"]Post Cardiac Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="PULMONARY"] [checklistInput type="scale"]Pneumonia[/checklistInput] [checklistInput type="scale"]COPD[/checklistInput] [checklistInput type="scale"]Tuberculosis[/checklistInput] [checklistInput type="scale"]Pulmonary Embolism[/checklistInput] [checklistInput type="scale"]Tracheostomy Management[/checklistInput] [checklistInput type="scale"]CPAP/BiPAP[/checklistInput] [checklistInput type="scale"]Interpretation of Arterial Blood Gases[/checklistInput] [checklistInput type="scale"]Post Lung Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="NEUROLOGICAL & PSYCHIATRIC"] [checklistInput type="scale"]Stroke Scale Assessment[/checklistInput] [checklistInput type="scale"]Traumatic Brain Injury[/checklistInput] [checklistInput type="scale"]CVA[/checklistInput] [checklistInput type="scale"]Post Craniotomy[/checklistInput] [checklistInput type="scale"]Seizure Disorders[/checklistInput] [checklistInput type="scale"]Spinal Cord Injuries[/checklistInput] [checklistInput type="scale"]Mood Disorders[/checklistInput] [checklistInput type="scale"]Substance Withdrawal[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="ORTHOPEDICS"] [checklistInput type="scale"]Circulation/Skin Checks[/checklistInput] [checklistInput type="scale"]Continuous Passive Motion Devices[/checklistInput] [checklistInput type="scale"]Ambulation Assistive Devices[/checklistInput] [checklistInput type="scale"]Prosthetics[/checklistInput] [checklistInput type="scale"]Cast Care[/checklistInput] [checklistInput type="scale"]Pin Care[/checklistInput] [checklistInput type="scale"]Traction[/checklistInput] [checklistInput type="scale"]Total Joint Replacement[/checklistInput] [checklistInput type="scale"]Amputation[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="GASTROINTESTINAL"] [checklistInput type="scale"]Bariatrics[/checklistInput] [checklistInput type="scale"]Feeding Tubes[/checklistInput] [checklistInput type="scale"]GI Bleeding[/checklistInput] [checklistInput type="scale"]Bowel Obstruction[/checklistInput] [checklistInput type="scale"]GI Surgery[/checklistInput] [checklistInput type="scale"]Liver Disease[/checklistInput] [checklistInput type="scale"]Pancreatitis[/checklistInput] [checklistInput type="scale"]Post Liver Transplant[/checklistInput] [checklistInput type="scale"]Post Pancreas Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="RENAL/GENITOURINARY"] [checklistInput type="scale"]Arteriovenous Fistula/Shunt[/checklistInput] [checklistInput type="scale"]3 Way Catheter & Bladder Irrigation[/checklistInput] [checklistInput type="scale"]Suprapubic Catheter[/checklistInput] [checklistInput type="scale"]Renal Failure[/checklistInput] [checklistInput type="scale"]Peritoneal Dialysis[/checklistInput] [checklistInput type="scale"]GU Surgery[/checklistInput] [checklistInput type="scale"]Nephrostomy Tubes[/checklistInput] [checklistInput type="scale"]Renal Transplant[/checklistInput] [checklistInput type="scale"]Management Pre/Post Hemodialysis[/checklistInput] [checklistInput type="scale"]Gyn Surgery[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="ENDOCRINE METABOLIC"] [checklistInput type="scale"]Diabetes Type I[/checklistInput] [checklistInput type="scale"]Diabetes Type II[/checklistInput] [checklistInput type="scale"]Blood Glucose Monitoring[/checklistInput] [checklistInput type="scale"]IV Insulin Protocols[/checklistInput] [checklistInput type="scale"]Management of Hypoglycemia[/checklistInput] [checklistInput type="scale"]Indwelling Insulin Pumps[/checklistInput] [checklistInput type="scale"]Pituitary Disorders[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="ONCOLOGY"] [checklistInput type="scale"]Chemotherapy Administration[/checklistInput] [checklistInput type="scale"]Radiation Therapy[/checklistInput] [checklistInput type="scale"]Medical Oncology[/checklistInput] [checklistInput type="scale"]Surgical Oncology[/checklistInput] [checklistInput type="scale"]Radiation Implants[/checklistInput] [checklistInput type="scale"]Bone Marrow Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="MEDICATIONS"] [checklistInput type="scale"]Antiarrhythmics[/checklistInput] [checklistInput type="scale"]Anticoagulants (IV, oral, & injection)[/checklistInput] [checklistInput type="scale"]Anti-Depressants[/checklistInput] [checklistInput type="scale"]Anti-Hypertensives[/checklistInput] [checklistInput type="scale"]Anti-Psychotics[/checklistInput] [checklistInput type="scale"]Benzodiazepines[/checklistInput] [checklistInput type="scale"]Emergency Medications[/checklistInput] [checklistInput type="scale"]Epidural Analgesia[/checklistInput] [checklistInput type="scale"]Inhaled Medications[/checklistInput] [checklistInput type="scale"]Insulin[/checklistInput] [checklistInput type="scale"]Narcotics/Opioid Analgesics[/checklistInput] [checklistInput type="scale"]Nitrates (Oral & Topical)[/checklistInput] [checklistInput type="scale"]Oral Hypoglycemics[/checklistInput] [checklistInput type="scale"]Patient Controlled Analgesia[/checklistInput] [checklistInput type="scale"]Procedural Sedation Administration[/checklistInput] [checklistInput type="scale"]Reversal Agents[/checklistInput] [checklistInput type="scale"]Steroids (IV, Oral, Inhaled)[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="IV THERAPY"] [checklistInput type="scale"]Starting IVs[/checklistInput] [checklistInput type="scale"]Central Line Blood Draws[/checklistInput] [checklistInput type="scale"]Central Line/Implanted Line Care[/checklistInput] [checklistInput type="scale"]TPN & Lipids[/checklistInput] [checklistInput type="scale"]Blood Product Administration[/checklistInput] [checklistInput type="scale"]Monitoring of Chemotherapy[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="CARDIAC MONITORING & EMERG. RESPONSE"] [checklistInput type="scale"]Placement of Telemetry Leads[/checklistInput] [checklistInput type="scale"]Rhythm Interpretation[/checklistInput] [checklistInput type="scale"]Dysrhythmia Management[/checklistInput] [checklistInput type="scale"]Obtain 12 Lead EKG[/checklistInput] [checklistInput type="scale"]Use of Rapid Response Teams[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="PROFESSIONAL KNOWLEDGE AND SKILLS"] [checklistInput type="scale"]National Patient Safety Goals/Core Measures[/checklistInput] [checklistInput type="scale"]Fall Risk Assessment/Prevention[/checklistInput] [checklistInput type="scale"]Pressure Ulcer Risk Assessment/Prevention[/checklistInput] [checklistInput type="scale"]Restraints/Use of Least Restrictive Device[/checklistInput] [checklistInput type="scale"]Patient/Family Teaching[/checklistInput] [checklistInput type="scale"]Age Specific/Population-Based Care[/checklistInput] [checklistInput type="scale"]Isolation Precautions[/checklistInput] [checklistInput type="scale"]Infection Prevention[/checklistInput] [checklistInput type="scale"]Pain Assessment & Management[/checklistInput] [checklistInput type="scale"]Charge Experience[/checklistInput] [checklistInput type="scale"]Interpretation and Comm of Lab Values[/checklistInput] [checklistInput type="scale"]Wound Care /Wound Vac[/checklistInput] [checklistInput type="scale"]Specialty Beds[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]