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 (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young Adults Middle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    SETTINGS
    Acute Care/ Hospital ICU
    General Acute Care
    Rehabilitation
    Home Health
    Outpatient
    Psychiatric Hospitals
    Skilled Nursing Facility
    Pediatrics/PICU
    School
    Early Intervention
    Children's Hospital
    ORTHOPEDICS
    Arthritis
    Cervical/thoracic, lumbar spine treatment
    Chronic Fatigue
    Fibromyalgia
    Elbow,wrist,hand injury
    Halo Traction
    Kyphoplasty
    Pelvic Fractures
    Post operative conditions ( ACL,rotator cuff repair, hip arthroscopy)
    Shoulder,hip,knee,ankle arthroscopy
    Total Joint Replacement
    Temporomandibular Dysfunction
    NEUROLOGIC
    Adaptive Equipment
    ALS
    Brain Tumors
    Cerebral palsy
    Functional Splinting/Bracing
    Glasgow coma scale
    Traumatic Brain Injury
    Multiple Sclerosis
    Muscular Dystrophy
    Postoperative Neurosurgery Rehabilitation
    Neurodevelopment testing (NDT)
    Spinal Cord Injury
    Stroke Rehabilitation
    Wheelchair prescription
    PEDIATRICS
    Activities of Daily Living
    Adaptive Equipment
    Cerebral palsy
    Developmental Disability
    Gross Motor Assessment Tools
    Special Needs Patient
    Neurodevelopmental testing (NDT)
    Orthotics
    Spina Bifida
    Sequencing testing
    OTHER
    Aquatic Therapy
    Burn Management
    Cardiac Rehabilitation
    Chest Physiotherapy
    DME Ordering
    FIM scoring
    Functional Capacity Evaluation
    Job Task Analysis
    Lymphedema Management
    OASIS assessment for home health
    Obstetrics in Physical Therapy
    Tone Management /Spasticity
    Wheelchair/Equipment Assessment
    Wound care
    SPORTS MEDICINE
    Biodex/BTE Testing
    Bracing/Casting/Splinting
    Functional Movement Screening
    Immobilization
    Injury Prevention Programs
    Nautilus/Eagle
    Physical Performance Testing
    Strength/Endurance Training
    Stabilization techniques
    Taping/Strapping
    PROSTHETICS/ORTHOTICS
    Above Knee Prosthetics
    Ankle Foot Orthosis
    Below Knee Prosthetics
    Dynamic Splints
    Gait Analysis
    LE Prosthetics
    Orthoplast/Aquaplast
    Protonics
    Removable Rigid Dressings
    Serial/ Inhibitory Casting
    Static Splints
    UE Prosthetics
    MODALITIES
    Anodyne
    Biofeedback
    Continuous Passive Motion Machine
    Craniosacral Therapy
    Cryotherapy
    Diathermy
    Edema massage
    Fluidotherapy
    Ionotophoresis
    JOBST Compression Pump
    Massage
    Muscle Stimulation
    Myofascial Release Techniques
    Neuro Probe
    Paraffin
    Phonophoresis
    Strain/Counter Strain Techniques
    TENS
    Traction
    Ultrasound
    GENERAL SKILLS
    Electronic Documentation
    Other Electronic Documentation:
    Universal Precautions
    Working with patients in isolation
    Working with patients in restraints
    Patient/Family teaching
    Patient Identification
    Specialty beds
    End of life care/palliative care
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores