Name * First Name Last Name Email * Date * MM DD YYYY Evaluation of Occupational Therapy in Various Settings Experience with Outpatient Therapy (18+ years old) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Acute Care Inpatient Hospital Evaluation Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Comprehensive Rehabilitation Inpatient Evaluation Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Skilled Nursing / Extended Care Evaluation Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Home Care Evaluation Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Comprehensive, Evidence-Based Occupational Therapy Treatments Experience with Outpatient Therapy (18+ years old) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Acute Care Inpatient Hospital Treatment Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Comprehensive Rehabilitation Inpatient Treatment Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Skilled Nursing / Extended Care Treatment Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Home Care Treatment Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Vital Signs Monitoring Demonstration of BP & Pulse testing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalization of alternate measure placements Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Pulse Oxygen reading Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Indications for taking vital signs Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable ROM/GONIOMETRY Demonstration of using goniometer at selected joints Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Demonstration of checking functional ROM (recognizing pain limitations) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Demonstrate assessment of end feel/joint integrity Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalize contraindications for ROM testing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable MMT/STRENGTH Demonstration of testing muscle strength at selected joints (use of dynamometer as indicated) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalization of testing functional strength Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalization contraindications for MMT testing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Balance Examples of testing balance (e.g. 5 Time Sit to Stand, Functional Reach, FIST) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalization and examples of functional progressive balance exercises Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Coordination Examples of coordination/gross motor function tests (finger to nose, heel to shin, heel to toes, alternating rapid movement, cross body movement) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Fine motor-functional dressing (button/zipper), self-care Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Sensation/Proprioception Verbalization of examples of sensation tests (Hot/Cold, Two point, Sharp/Dull, Light touch/Pressure) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Recognize deficits in proprioception and provide treatment strategies Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Muscle Tone/Reflex Verbalization of muscle tone (Increased, Decreased, Flaccid, Paresis, Paralysis, Paresthesia, Hyperesthesia, Kynesthesia) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Edema Demonstration of pitting test Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Edema measurement sites Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Examples of edema reduction techniques Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Identify indications for lymphedema management Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Ambulation Devices Assistive Devices Demonstrate proper height adjustment and fitting for each device. Monitor patient safety and effectiveness during functional use. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Beds Bed Height & Positioning Ensure proper bed height and location to support safe transitions. Verbalize correct patient positioning at the edge of the bed to promote stability and safety. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Modifications Discuss rails vs. trapeze vs. hospital bed (electrical vs. manual) Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable O2 Change tank Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Adjust liter flow Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Flow rate reading Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Nasal canula application Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Safety instruction No smoking Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Pulse oxygen Indication Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Strengthening Progression Strengthening modalities Use tools like resistance bands, weights, pedal bikes, and wheelchair push-ups. Progress from bed to sitting to standing, emphasizing functional strength for daily activities. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Hoyer/Overhead Lift Lift system safety Verbalize proper use of Hoyer and overhead lifts, including sling selection, adjustment, fixation, and caregiver instruction with demonstration when possible. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Indications Trunk control Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Seating and Mobility Wheelchair Indications Power vs. manual Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Wheelchair fitting Ensure proper adjustment of leg rests, armrests, seat depth, width, height, and table access, considering cushion placement. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Wheelchair cushion fitting Proper fitting of cushion and indication for different cushion types Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Orthotics/Prosthetics Indication and types of hand splints, prosthetics, slings-based on prognosis, dysfunction Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Indication and types of bracing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Make appropriate recommendations based on physical presentation of the patient Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Education on splint wearing schedule Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Endurance Borg/RPE Rate of perceived exertion scale Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Recognize signs and symptoms of endurance limitations Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Posture Demonstrate proficiency in normal postural alignment in sitting and standing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Body Mechanics Use of transfer/gait belt Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Proper body mechanics for bending, lifting, reaching and computer ergonomics Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Pain Faces scale Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbal analog scale Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Visual analog scale Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Pain management techniques Verbalize traditional and alternative therapies Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Identify ineffective and inappropriate pain management and appropriate follow-up Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Mental/Cognitive Status Alert and oriented x4 Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Patient’s current level of alertness, orientation, comprehension, concentration, and immediate memory for simple commands. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Examples of cognitive assessments MOCA, Short Blessed, TMYB Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Home Safety/Environmental Adaptations Evaluation and adaptation of environmental barriers in bathroom, bedroom, kitchen, entrance/exit Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Suggestive adaptive equipment/durable medical equipment Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Functional Mobility Mobility & Transfers Demonstrate, assess, and instruct on bed mobility, transfers, ambulation, and wheelchair management. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable ADLS Assess and teach basic toileting, dressing, grooming and bathing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Assess and teach advanced meal prep, housekeeping, laundry Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Assess medication management and strategies Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Integumentary Identification of impaired integumentary system Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Treatment ideas and referral indications Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Recognize signs and symptoms of infection Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Use of Physical Agents Ultrasound Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Electrical Stimulation TENS, FES, Neuromuscular, Transcutaneous Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Cryotherapy Cold packs, ice massage, hydrotherapy Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Thermotherapy Dry heat, hot packs, paraffin, hydrotherapy Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Cardio-Pulmonary Identify indications for pulm exercise and postural drainage Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Teach Caregiver/Patient energy conservation Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable DME Patient and caregiver training Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Measuring and sizing Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Verbalize ordering process Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Other Patient Precautions Recognize and address allergies, medication reactions, bleeding risks, fall precautions, and seizure precautions for the treated population. Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Medication baseline knowledge Have you performed this? * Yes No Are you competent in this setting? * Yes No Self-Rating * 1 - No experience 2 - Novice (needs guidance) 3 - Advanced beginner (some experience) 4 - Competent (independent in routine cases) 5 - Proficient (handles complexity with ease) 6 - Advanced (expert-level) N/A - Not applicable Please describe any other clinical competencies, advanced skills, strengths/weakness that you wish to highlight. Print Signature * Thank you!
