Medical Assistant Skills Checklist - Welcome to Specialty

1 Medical AssistantSkills 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 monthsGENERAL DUTIESE xperience ADMIT PATIENTS12345 DISCHARGE PATIENTS12345 VITAL SIGN MONITORING12345 PULSE OXIMETRY12345 URINE DIPSTICK12345 BLOOD GLUCOSE MONITORING12345 WOUND CARE12345 DRESSING CHANGES12345 POSITIONING / TRANSFERRING12345 ISOLATION TECHNIQUES12345 DOCUMENTATION12345 REPORTING TO SUPERVISOR12345 ASSIST W/ PATIENT HEALTH HISTORY12345 ASSIST WITH PATIENT EXAMS12345 ASSIST WITH THERAP.

2 MEASURES12345 ASSIST WITH THERAP. PROCEDURES12345 REQUEST XRAY STUDIES AS ORDERED12345_____InitialsVersion: 07/03/2012 Page 1 out of 3 Medical AssistantSkills ChecklistGENERAL DUTIESE xperience REQUEST LAB STUDIES AS ORDERED12345 ASSIST WITH HEALTH EDUCATION12345 ASSIST WITH DISCHARGE INSTRUCTIONS12345 PERFORM PROCEDURES12345 PERFORM TREATMENTS12345 ASSIST WITH DIAGNOSTIC TESTING12345 ASSIST WITH DIAGNOSTIC PROCEDURES12345 OBSERVE FOR MEDICATION ADVERSE RXN12345 ALERT LICENSED STAFF TO ADVERSE RXN12345 HIPAA REGULATIONS12345 SCREEN / DIRECT PATIENT PHONE CALLS12345 RECEIVE PROVIDER CALLS12345 COORDINATE / SCHEDULE REFERRALS12345 PREPARE REPORTS AS NEEDED12345 ADMINISTRATIVE TASKS12345 OBTAIN / INSTRUCT CLEAN

3 CATCH URINE12345 CARDIACE xperience USE OF CARDIAC MONITORS12345 PERFORM 12-LEAD EKG12345 TELEMETRY12345 ASSIST WITH CODE12345 ORTHOPEDICE xperience CRUTCH WALKING12345 TRACTION12345 CAST CARE12345 VASCULARE xperience APPLY NONINVASIVE BP MONITOR12345 MONITOR NONINVASIVE BP MONITOR12345 DRAW BLOOD FOR LAB STUDIES12345 DISCONTINUE PERIPHERAL IVS12345_____InitialsVersion: 07/03/2012 Page 2 out of 3 The information represented above is true and correct to the best of my knowledge. I also authorizeSpecialty Professional Services, Corp to share the above Skills Checklist with its facility clients. Medical AssistantSkills ChecklistVASCULARE xperience INTAKE AND OUTPUT12345 RESPIRATORYE xperience FACE MASKS12345 NASAL CANNULA12345 INCENTIVE SPIROMETRY12345 O2 SATURATION MONITORS12345 O2 SATURATION SPOT CHECKS12345 OPEN / MONITOR AIRWAY12345 NEUROLOGYE xperience NEUROLOGICAL EVALUATION12345 GLASCOW COMA SCALE12345 ASSIST WITH LUMBAR PUNCTURE12345 SEIZURE PRECAUTIONS12345 GASTROINTESTINALE xperience ASSIST WITH NUTRITIONAL EVALUATION12345 ASSIST WITH FEEDINGS12345 STRAIGHT / FOLEY CATH FEMALE12345 STRAIGHT / FOLEY CATH MALE12345 AGE APPROPRIATE CAREE xperience NEWBORN (BIRTH-30 DAYS)

4 12345 INFANT (30 DAYS - 1 YEAR12345 TODDLER (1 - 3 YEARS)12345 PRESCHOOLER (3 - 5 YEARS)12345 SCHOOL AGE (5 - 12 YEARS)12345 ADOLESCENTS (12 - 18 YEARS)12345 YOUNG ADULTS (18 - 39 YEARS)12345 MIDDLE ADULTS (39 - 64 YEARS)12345 OLDER ADULTS (64+ YEARS)12345_____SignatureDate CompletedFax: 718-225-9421 Version: 07/03/2012 Page 3 out of 3)