[checklist name="Medical Social Worker" mailto="[email protected]" templatedoc="1o12VlIMoxmoqzxgRvV_EJR5BXdu9cyKKosQ6FCrZnHY" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Medical Social Worker"] 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="MSW Skills"] [checklistInput type="scale"]Knowledge of Assessment Process[/checklistInput] [checklistInput type="scale"]Reviewing health history and examination[/checklistInput] [checklistInput type="scale"]Development of problem list[/checklistInput] [checklistInput type="scale"]Development and revision of care plan[/checklistInput] [checklistInput type="scale"]Assess response to treatment[/checklistInput] [checklistInput type="scale"]Establish and revise goals[/checklistInput] [checklistInput type="scale"]Conduct complete initial evaluation[/checklistInput] [checklistInput type="scale"]Documenting initial assessment and evaluation[/checklistInput] [checklistInput type="scale"]Skilled visit notes[/checklistInput] [checklistInput type="scale"]Physician's orders[/checklistInput] [checklistInput type="scale"]Discharge summary[/checklistInput] [checklistInput type="scale"]Adhere to plan of care[/checklistInput] [checklistInput type="scale"]Review POC prior to care[/checklistInput] [checklistInput type="scale"]Performs services as ordered[/checklistInput] [checklistInput type="scale"]Documents according to POC[/checklistInput] [checklistInput type="scale"]Coordinates/Communicates with other staff[/checklistInput] [checklistInput type="scale"]Knowledge of medical/state guidelines[/checklistInput] [checklistInput type="scale"]Evaluate criteria for participation[/checklistInput] [checklistInput type="scale"]Skilled reimbursable visit[/checklistInput] [checklistInput type="scale"]Effective case coordination[/checklistInput] [checklistInput type="scale"]Reports key info to physicians and case managers[/checklistInput] [checklistInput type="scale"]Document info for RN/LPN, PT, OT, ST[/checklistInput] [checklistInput type="scale"]Utilize community resources[/checklistInput] [checklistInput type="scale"]Participates in case reviews[/checklistInput] [checklistInput type="scale"]Knowledge of Infection Control[/checklistInput] [checklistInput type="scale"]Follow hand washing policies[/checklistInput] [checklistInput type="scale"]Use of PPE[/checklistInput] [checklistInput type="scale"]Familiar with exposure plans[/checklistInput] [checklistInput type="scale"]Determine patient learning needs[/checklistInput] [checklistInput type="scale"]Setting learning objectives[/checklistInput] [checklistInput type="scale"]Set/Execute teaching plan[/checklistInput] [checklistInput type="scale"]Evaluate effectiveness of teaching plan[/checklistInput] [checklistInput type="scale"]Revises teaching plan to meet needs[/checklistInput] [checklistInput type="scale"]Note patient response to teaching plan[/checklistInput] [checklistInput type="scale"]Completing psychological assessment[/checklistInput] [checklistInput type="scale"]Completing financial assessment[/checklistInput] [checklistInput type="scale"]Complete terminal care assessment[/checklistInput] [checklistInput type="scale"]Counseling for long range planning[/checklistInput] [checklistInput type="scale"]Short term therapy associated w/ illness[/checklistInput] [checklistInput type="scale"]High risk intervention[/checklistInput] [checklistInput type="scale"]Evaluate patient for long term placement[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]