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)
    GENERAL SKILLS
    Hospital Experience
    Clinic Experience
    Teaching/Educational Facility
    Vital Signs
    Care of patients in restraints
    Use of transfer/lifting devices
    Care of patients in isolation
    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
    ECHO
    3-D Echo
    2-D
    M-Mode
    Pulsed Wave Doppler
    Continuous Wave Doppler
    Color Doppler
    Pedoff probe in apical
    Pedoff probe in suprasternal
    Pedoff probe in parasternal right
    4 chamber view
    2 chamber view
    Subcostal view
    Suprasternal view
    Pulmonary Veins
    Hepatic Veins
    Continuity Equation
    PISA
    Diastolic Dysfunction Study
    Simpson's Rule
    Cardiac Anatomy
    LV Strain/LV Volume
    SPECIAL PROCEDURES
    Treadmill Stress Echo
    Pharmacological Stress Echo
    Transesophageal Echo
    Bubble Study
    Contrast Study
    Pediatric post-surgical scans ( Arterial switch, Blalock-Taussig)
    Fontan, Glenn, Konno, Norwood, Rastelli Sano, Sennig)
    Cardiac Anomalies - Aortic arch abnormailities, Coronary arter amonlies
    Tetralogy of Fallot
    Transposition of the Great Vessel
    OTHER TESTING:
    Saline Infused Sonohysterography (SIS)
    Amniocentesis
    Holter Monitors
    Carotid Ultrasound
    Venous (arm/leg)
    Arterial (arm/leg)
    Hysterosonography
    Biopsy
    Transvaginal
    Testicular
    Gallbladder
    Renal
    Abdominal/Pelvis
    Renal
    OB/GYN exams
    Drainage
    GENERAL ULTRASOUND
    Aorta
    Appendix
    Biliary Tract
    Gall Bladder
    Intra Operative Ultrasound
    Liver
    Lung Biopsy
    Pancreas
    Paracentesis,thoracentesis
    Renal/Cyst Aspiration
    Pelvic male
    Ultrasound Guided Biopsy
    PELVIC FEMALE
    Adnexa
    Endometrial
    Ovaries
    Transvaginal
    Uterus
    Amniotic fluid (normal and abnormal)
    Crown rump length
    Fetal demise
    Left Ventricular outflow tract
    Right Ventricular outflow tract
    Multiple pregnancy
    Lower uterine segment
    Nuchal Translucency
    Placenta Previa
    High Risk OB
    VASCULAR
    M-Mode
    Color Flow
    Real Time
    Duplex
    Flow Studies
    Photoplethysmography
    Strain Gauge and Pneumoplethysmography
    Continuous Wave Doppler
    Area of Percentage of Stenosis
    Diameter for Percentage of Stenosis
    Post Void Residual
    Impedance Plethysmography (IPG), R/O DVT
    Palmer Arch
    Pulse Volume Recording
    Segmental Pressures
    Abdomen and Pelvis
    Arterial - Aorta
    Arterial/Venous - Superior Mesenteric
    Arterial - Celiac
    Arterial/Venous - Hepatic
    Arterial/Venous - Iliacs
    Arterial/Venous Renal
    Arterial/Venous - Splenic
    Venous - Inferior Vena Cava
    Venous - Portal
    Arterial Peripheral Vasculature
    Upper Extremity
    Digital
    Dialysis Graft
    Lower Extremity
    Digital
    Graft Patency
    Venous Peripheral Vasculature
    Upper Extremity
    Lower Extremity
    Vein Mapping
    Reflux Testing (valve competence)
    Color Doppler imaging
    Cardiac Vasculature
    Stress/pressure Testing:
    Segmental Pressures
    Volume Pulse recording
    Pulse Cuff recording
    Digital pressure
    Reactive Hyperemia/Post exercise
    Neck Vasculature
    Carotid Arteries
    Vertebral Arteries
    Subclavian Arteries
    EQUIPMENT
    GE
    Hitachi
    HP
    Phillips
    Picker
    Siemens
    Toshiba