Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
  • AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (1 month to 1 year)
    Toddler (1 year to 3 years)
    Preschooler (3 years to 5 years)
    School Age Child (5 years to 12 years)
    Adolescents (12 years to 18 years)
    Young Adults (18 years to 39 years)
    Middle Adults (39 years to 64 years)
    Older Adults (64 years to 79 years)
    Elderly Adults (over 79+ years)
    SKILLED ENVIRONMENTS
    Acute Care/ Hospital
    Managed Care
    SNF/ Long Term Care
    Home Health
    Outpatient
    Clinical Dietitian
    Community Dietician
    Management Dietician
    GENERAL DIETICIAN EXPERIENCE
    Written Communication Skills
    Verbal Communication Skills
    Basic Negotiation Skills
    Job Related Computer Skills
    Ability to Prioritize
    Ability to Critically Think in Overall Practice
    Show Cultural Competence/Sensitivity with all Clients
    Ability to Develop Nutrition Education
    Ability to Develop Meal and Nutrition Plans within Patient Budget
    Ability to Work Effectively in All Situations
    Ability to Assess, Plan, Implement and Evaluate Individual Patient Care Programs and Nutritional Guidelines
    Council Patients on Healthy Eating and Nutrition Issues
    Ensure Outcomes are Met within an Appropriate Length of Stay
    Coordinate and Monitor Nutritional Services
    Coding and Billing for Nutrition and Diatetics Services for Reimbursement
    Document All Client Encounters
    Knowledge of Nutrition and its Role in Diseases and Illnesses
    Patient and Family Education
    Knowledge and Development of Plan with Eating Disorders