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Family Medicine

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age-Specific Competencies

Newborn/neonate (birth-30 days)*

Infant (31 days - 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age (5 years - 12 years)*

Adolescents (13 years - 21 years)*

Young Adults (22 years to 39 years)*

Middle Adults (39 years to 64 years)*

Older Adults (64 years to 79 years)*

Elderly Adults (over 79+ years)*

Collaboration

Collaboration and Education for Family/Support System*

Consulting Community Resources*

Consulting with Physicians*

Consulting with Interdisciplinary Team*

Referral to Pastoral Services*

Areas Worked

Anesthesiology*

Cardiology*

Corporate Health*

Critical Care*

Dermatology*

Emergency Medicine*

Ears, Nose, and Throat*

Correctional Care*

Family Practice*

Forensic Medicine*

Genetics*

Internal Medicine*

Interventional Radiology*

Substance Abuse*

Ob and Gynecology*

Occupational Medicine*

Ophthalmology*

Oncology*

Pain Medicine*

Pathology*

Pediatrics*

Physical Med/Rehab*

Psychiatry*

Public Health*

Radiation Oncology*

Surgery*

Trauma*

Non-Clinical*

Respiratory

Anaphylaxis*

Asthma*

Croup*

Influenza*

Tracheobronchitis*

Bronchitis*

ARDS*

Chronic Obstructive Pulmonary Disease (COPD)*

Pneumothorax*

Pulmonary Edema*

Pulmonary Embolism*

Upper Respiratory Infection (URI)*

Tuberculosis*

Obstructive Sleep Apnea*

Viral Pneumonia*

Bacterial Pneumonia*

Shock*

Sinusitis*

Oxygen Administration*

Liquid Oxygen*

IPPB Machine Use*

Tracheotomies*

Interpret ABG (Blood Gases)*

Intubations/Extubating*

Sputum Collection*

Cardiovascular System

Adult Cardiac Arrest*

Pediatric Cardiac Arrest*

Congestive Heart Failure*

Chronic Obstructive Pulmonary Disease*

Stasis Ulcer of Lower Extremities*

Angina*

Pericarditis*

Abdomnial Aortic Aneurysm*

Coronary Artery Disease*

Functional Murmurs*

Congenital Heart Disease*

Hypertension*

Arteriosclerotic Heart Disease (ASHD)*

Dyslipidemia*

Peripheral Vascular Disease (PVD)*

Peripheral Neuropathy*

Interpreting 12 Lead EKGs*

Recognizing Arrhythmias*

Cardioversion*

Pacemakers*

Thrombolytic Therapy*

Shock*

Neurological

Vasovagal Syncope*

Migraines*

Multiple Sclerosis*

Head Injury*

Spinal Cord Injury**

Anxiety*

Parkinson's*

Alzheimer's*

Bell's Palsy*

TIA / CVA*

Trigeminal Neuralgia*

Seizures*

Lumbar Puncture*

Shock*

OB/GYN

Candida Vaginitis*

Dysmenorrhea*

Bartholin's Cyst/Abscess*

Abnormal Pap Smear Findings*

Pap Smears*

Sexually Transmitted Infections*

Fibrocystic Breast Disease*

Menopause*

Dysfunctional Uterine Bleeding*

Birth Control Methods*

Prenatal Care*

Pregnancy - Diagnosis and Referral*

Spontaneous Abortion*

Pre-Eclampsia/Eclampsia*

HELLP Syndrome*

Placental Previa*

Placental Abruption*

Fetal Heart Tones*

Nausea and Vomiting with Pregnancy*

Rh Blood Factor*

Fetal Well-Being*

Intrapartum Medications*

Medications in the Third Stage*

Preparation for Childbirth*

Emergency Delivery*

Hemorrhage*

Pain Relief in Active Phase of Labor*

Mediations in the Postpartum Phase*

Mastitis*

GI System

Constipation*

Diarrhea*

Irritable Bowel Syndrome (IBS)*

Colic*

Acute Gastroenteritis*

G.I. Bleed*

Hemorrhoids*

Cholecystitis*

Hiatal Hernia*

Pyloric Stenosis*

Appendicitis*

Duodenal Ulcer*

Hepatitis*

Naso-Gastric Tubes*

Gastrostomy Care*

Parasitic Infections*

Genitourinary System

Syphilis*

Chlamydia*

Herpes*

Cystitis*

Pyelonephritis*

Urinary Tract Infection (UTI)*

Renal Failure*

Renal Calculi*

Benign Prostatic Hypertrophy*

Vulvovaginitis*

Hypospadias*

Hydrocele*

Gonococcal Infections*

Prostatitis*

Catheter Care*

Incontinence Care - Bowel*

Dermal Ulcers*

Enemas / Suppositories / Fecal*

Urine Collection*

Dialysis*

Dermatology

Warts*

Basal Cell Carcinoma*

Scabies*

Impetigo*

Diaper Dermatitis*

Acne*

Folliculitis*

Furuncles*

Carbuncles*

Herpes Simplex*

Herpes Zoster*

Malignant Melanoma*

Pityriasis Rosea*

Contact Dermatitis*

Tinea Corporis*

Tinea Pedis*

Staph Infections*

Wound Care*

Animal Bites*

Snake Bites*

Burns*

Single-Layer Wound Closure*

Suturing*

Incision and Drainage*

Excisions*

Cell Biopsy*

Ears, Nose, and Throat

Epistaxis*

Otitis Externa*

Serous Otitis Media*

Acute Purulent Otitis Media*

Allergic Rhinitis*

Pharyngitis*

Oral Candidiasis*

Audiometry*

Tympanometry*

Eye

Conjunctivitis*

Strabismus*

Chalazion*

Stye*

Visual Acuity*

Fluorescein Staining of Eyes*

Musculoskeletal

Osteoporosis*

Osteomyelitis*

Rheumatoid Arthritis*

Juvenile Diabetes*

Gout*

Minor Sprains and Strains*

Cast/Splint Application*

Osteoarthritis*

Carpal Tunnel Syndrome*

Scoliosis*

Tendonitis*

Bursitis*

Muscular Dystrophy*

Closed Fracture/Dislocation Reduction*

Moderation Sedation*

Richmond Agitation and Sedation Scale (RASS)*

Endocrine

Type I Diabetes Mellitus*

Type II Diabetes Mellitus*

Graves' Disease*

Addison's Disease*

Juvenile Diabetes*

Hypoglycemia*

Hypothyroidism*

Psychosocial

Depression*

Anxiety*

Mental Illness Diagnosis*

Suicide*

Overdose*

Ingestions and Poisonings*

ETOH Abuse/DTs*

Eating Disorders*

Grief*

Care of a Patient in Restraints*

Drug Therapy

Prescription*

Over the Counter (OTC)*

Herbal Drugs*

Knowledge of Pharmacology*

Knowledge of Pharmacokinetics*

Knowledge of Drug Interactions*

Knowledge of Side Effects*

Knowledge of Potential Adverse Reactions*

Allergic Reactions*

Anaphylaxis Reaction*

TPN/Lipid Management*

Management/Titration of IV Therapies*

IV/PO Antibiotic Therapy and Understanding of Cultures*

Dispensing Medication

Monitoring Drug Therapy*

Management of Controlled Substances*

Injections*

Non-Pharmacologic Interventions

Medical Nutrition Therapy*

Exercise*

Cessation of Substance Abuse (Alcohol, Tobacco)*

Mental Health Issues (Stress Management, Depression)*

Obesity Management*

Tube Feeding Management*

Miscellaneous

Research*

Quality Assurance*

Leadership and Teaching Skills*

Legal and Ethical Issues*

Confidentiality*

Cultural Awareness*

Self-Evaluation to Improve Patient Care*

Continuing Education*

Working Within Scope of Practice*

Care Planning*

Discharge Planning*

Starting IV*

Isolation Precautions*

Radiographic Interpretation (Initial)*

Interpreting Lab Results*

Informed Consent*

Explanation to Patient/Family*

Abuse Signs/Reporting*

Venipuncture*

Ultrasounds*

Documentation*

EMR Documentation*

Programs

Occupational Safety and Health Administration (OSHA)*

Medicare and Medicaid*

Clinical Laboratory Improvement Amendments (CLIA Waiver)*

The Joint Commission (TJC)*

Health Plan Employer Data and Information Set (HEDIS)*

Diabetes Quality Improvement Plan (DQIP)*

Health Insurance Portability & Accountability Act (HIPAA)*

HCAHPS*

Other Skills
Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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