Interventional Radiology Skills Checklist

Interventional RadiologySkills Checklist_____XXX-XX-_____Print NameLast 4 of SS #Date CompletedDirectionsPlease circle a value for each question toprovide us and the interested facilities withan assessment of your clinical values confirm your strengths withinyour specialty and assist the facility in theselection process of the 1 - No Experience (has never done or observed) 2 - Requires Training (In-Service) - not performed within last 36 months 3 - Limited Experience (requires assistance or training) - performed within the last 24 months 4 - Experienced (routinely performs without assistance) - performed within the last 12 months 5 - Able to Supervise, Precept and Teach - performed within the last 6 monthsGENERALE xperience ADMIT PATIENT TO PRE PROCEDURE HOLDING12345 PATIENT ASSESSMENTS / OBTAIN FAMILY HISTORY12345 START PERIPHERAL IV12345 COMPLETE PRE-PROCEDURE CHECKLIST12345 TRANSPORT PRE-PROCEDURE PATIENT LAB12345 TRANSPORT POST-PROCEDURE PATIENT LAB12345 TRANSPORT POST-PROCEDURE PATIENT TO UNITS12345 PROCEDURESE xperience CEREBRAL ANGIOGRAM-PREPARE12345 CEREBRAL ANGIOGRAM - ASSIST12345 LOWER EXTREMITY ANGIOGRAM PREPARE12345 LOWER EXTREMITY ANGIOGRAM ASSIST12345 UPPER EXTREMITY ANGIOGRAM PREPARE12345 UPPER EXTREMITY ANGIOGRAM ASSIST12345 ULTRASOUND GUIDED BIOPSY - PREPARE12345 ULTRASOUND GUIDED BIOPSY - ASSIST12345 CT SCAN GUIDED B

The information represented above is true and correct to the best of my knowledge. I also authorize Specialty Professional Services, Corp to share the above skills checklist with its facility clients.

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  Skills, Checklist, Interventional, Radiology, Interventional radiology skills checklist

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