[checklist name="Pharmacist Skills Checklist" mailto="credentialing@teemagroup.com" templatedoc="1OUc15TbFrtOHcwpOOBIpJtsYYsEaTa73FBWLy2z9NbY" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Pharmacist Skills Checklist"] 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="date" default="none"]Submit Date[/checklistInput] [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="Practice Settings/Experience"] [checklistInput type="scale"]Academia[/checklistInput] [checklistInput type="scale"]Ambulatory Care[/checklistInput] [checklistInput type="scale"]Clinic[/checklistInput] [checklistInput type="scale"]Compounding[/checklistInput] [checklistInput type="scale"]Temporomandibular[/checklistInput] [checklistInput type="scale"]Consulting[/checklistInput] [checklistInput type="scale"]Correctional Facility (Jail)[/checklistInput] [checklistInput type="scale"]Diabetes[/checklistInput] [checklistInput type="scale"]Drug Information[/checklistInput] [checklistInput type="scale"]Formulary Management[/checklistInput] [checklistInput type="scale"]Geriatrics[/checklistInput] [checklistInput type="scale"]Home Health[/checklistInput] [checklistInput type="scale"]Home Infusion[/checklistInput] [checklistInput type="scale"]Hospital– Inpatient[/checklistInput] [checklistInput type="scale"]Hospital– Outpatient[/checklistInput] [checklistInput type="scale"]Infectious Disease[/checklistInput] [checklistInput type="scale"]Long Term Care[/checklistInput] [checklistInput type="scale"]Mail Order[/checklistInput] [checklistInput type="scale"]Military/Government/VA [/checklistInput] [checklistInput type="scale"]Nuclear[/checklistInput] [checklistInput type="scale"]Oncology[/checklistInput] [checklistInput type="scale"]Pain Management[/checklistInput] [checklistInput type="scale"]Pediatrics[/checklistInput] [checklistInput type="scale"]Pharmaceutical Research[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Pharmacy Software Systems"] [checklistInput type="scale"]HBS[/checklistInput] [checklistInput type="scale"]Etreby[/checklistInput] [checklistInput type="scale"]JASRx[/checklistInput] [checklistInput type="scale"]McKesson– 3PM[/checklistInput] [checklistInput type="scale"]McKesson– Pharmserv[/checklistInput] [checklistInput type="scale"]Meditech[/checklistInput] [checklistInput type="scale"]OPUS– ISM[/checklistInput] [checklistInput type="scale"]NDC[/checklistInput] [checklistInput type="scale"]OSCOR[/checklistInput] [checklistInput type="scale"]NDX[/checklistInput] [checklistInput type="scale"]PharmNet[/checklistInput] [checklistInput type="scale"]PROScript 2000[/checklistInput] [checklistInput type="scale"]QSI[/checklistInput] [checklistInput type="scale"]Renlar[/checklistInput] [checklistInput type="scale"]Rescot– Omni-DX[/checklistInput] [checklistInput type="scale"]Rx-Link[/checklistInput] [checklistInput type="scale"]Speed Script[/checklistInput] [checklistInput type="scale"]Tech RX[/checklistInput] [checklistInput type="scale"]WinPharm[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Automation"] [checklistInput type="scale"]Accumed/Baker Cells[/checklistInput] [checklistInput type="scale"]BAXA– Rapid-Fill (ASF)[/checklistInput] [checklistInput type="scale"]BAXA– Repeater Pump[/checklistInput] [checklistInput type="scale"]Baxter[/checklistInput] [checklistInput type="scale"]Baxter– AUTOMIX Compounder[/checklistInput] [checklistInput type="scale"]Baxter– MICROMIX Compounder[/checklistInput] [checklistInput type="scale"]Kirby Lester[/checklistInput] [checklistInput type="scale"]McKesson– AcuDose-Rx[/checklistInput] [checklistInput type="scale"]McKesson– Baker Scale[/checklistInput] [checklistInput type="scale"]McKesson– IntelliShelf-Rx[/checklistInput] [checklistInput type="scale"]McKesson– MedCarousel[/checklistInput] [checklistInput type="scale"]McKesson– ROBOT– Rx[/checklistInput] [checklistInput type="scale"]McKesson– PACMED[/checklistInput] [checklistInput type="scale"]MTS– Automated Sealers[/checklistInput] [checklistInput type="scale"]MTS– Prepackaging[/checklistInput] [checklistInput type="scale"]Parata– PACMED[/checklistInput] [checklistInput type="scale"]Parata– RDS[/checklistInput] [checklistInput type="scale"]Parata– APM[/checklistInput] [checklistInput type="scale"]PharmASSIST– RDS ROBOTx[/checklistInput] [checklistInput type="scale"]PharmASSIST– ROBOTx[/checklistInput] [checklistInput type="scale"]PharmASSIST– SmartCabinet[/checklistInput] [checklistInput type="scale"]PharmASSIST– SmartScale[/checklistInput] [checklistInput type="scale"]Pyxis[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Disease State Management"] [checklistInput type="scale"]AIDA/HIV[/checklistInput] [checklistInput type="scale"]Anticoagulation[/checklistInput] [checklistInput type="scale"]Asthma[/checklistInput] [checklistInput type="scale"]Cardiovascular Disease[/checklistInput] [checklistInput type="scale"]Chemotherapy[/checklistInput] [checklistInput type="scale"]Cystic Fibrosis[/checklistInput] [checklistInput type="scale"]Depression[/checklistInput] [checklistInput type="scale"]Diabetes[/checklistInput] [checklistInput type="scale"]Dyslipidemia[/checklistInput] [checklistInput type="scale"]Hormone Replacement Therapy[/checklistInput] [checklistInput type="scale"]Hypertension[/checklistInput] [checklistInput type="scale"]Osteoporosis[/checklistInput] [checklistInput type="scale"]Pain Management[/checklistInput] [checklistInput type="scale"]Smoking Cessation[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Clinical and Job related Experience"] [checklistInput type="scale"]Admixture[/checklistInput] [checklistInput type="scale"]Adolescent Care[/checklistInput] [checklistInput type="scale"]Aseptic Techniques[/checklistInput] [checklistInput type="scale"]Blister Packs[/checklistInput] [checklistInput type="scale"]Cart Check / Cart Fill[/checklistInput] [checklistInput type="scale"]Chemotherapy[/checklistInput] [checklistInput type="scale"]Computerized Physician Order Entry[/checklistInput] [checklistInput type="scale"]Consulting[/checklistInput] [checklistInput type="scale"]Discharge Counseling[/checklistInput] [checklistInput type="scale"]DME Equipment[/checklistInput] [checklistInput type="scale"]Drug Information[/checklistInput] [checklistInput type="scale"]Drug Information Rounds[/checklistInput] [checklistInput type="scale"]Drug Rehabilitation Programs[/checklistInput] [checklistInput type="scale"]Emergency Room[/checklistInput] [checklistInput type="scale"]Enteral Nutrition Products[/checklistInput] [checklistInput type="scale"]Formulary Management[/checklistInput] [checklistInput type="scale"]Geriatric Care[/checklistInput] [checklistInput type="scale"]Hazardous Drug Handling[/checklistInput] [checklistInput type="scale"]Homeopathic Treatments[/checklistInput] [checklistInput type="scale"]Hyperalimentation Calculation[/checklistInput] [checklistInput type="scale"]Immunizations[/checklistInput] [checklistInput type="scale"]Immunoglobulin Therapy[/checklistInput] [checklistInput type="scale"]Incontinence Supplies[/checklistInput] [checklistInput type="scale"]Infectious Diseases[/checklistInput] [checklistInput type="scale"]Infusion Pumps and Systems[/checklistInput] [checklistInput type="scale"]Intensive Care (ICU)[/checklistInput] [checklistInput type="scale"]IV Preparation[/checklistInput] [checklistInput type="scale"]Neonatal Intensive Care (NICU)[/checklistInput] [checklistInput type="scale"]Oncology[/checklistInput] [checklistInput type="scale"]Ostomy Supplies[/checklistInput] [checklistInput type="scale"]OTC selection and recommendations[/checklistInput] [checklistInput type="scale"]P&T committee participant[/checklistInput] [checklistInput type="scale"]Pain Management[/checklistInput] [checklistInput type="scale"]PCA Pumps[/checklistInput] [checklistInput type="scale"]Pediatric Care[/checklistInput] [checklistInput type="scale"]Poison Control[/checklistInput] [checklistInput type="scale"]Psychiatric Care[/checklistInput] [checklistInput type="scale"]Retail Compounding[/checklistInput] [checklistInput type="scale"]Surgical Supplies[/checklistInput] [checklistInput type="scale"]Tocolytic Therapy[/checklistInput] [checklistInput type="scale"]TPN Preparation[/checklistInput] [checklistInput type="scale"]Transplant Therapy[/checklistInput] [checklistInput type="scale"]Urological Supplies[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age Specific Competencies"] [checklistInput type="scale"]Infant (Birth - 1 year)[/checklistInput] [checklistInput type="scale"]Preschooler (ages 2-5 years)[/checklistInput] [checklistInput type="scale"]Childhood (ages 6-12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (ages 13-21 years) [/checklistInput] [checklistInput type="scale"]Young Adults (ages 22-39 years)[/checklistInput] [checklistInput type="scale"]Adults (ages 40-64 years)[/checklistInput] [checklistInput type="scale"]Older Adults (ages 65-79 years)[/checklistInput] [checklistInput type="scale"]Elderly (ages 80+ years)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]