Please rate your experience / frequency within the last year

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)

MM slash DD slash YYYY

AGE OF CLIENTS:

Newborn/Neonate (birth to 30 days)(Required)
Infant (31 days to 12 months)(Required)
Toddler/Preschool (13 months to 5 years)(Required)
School Age Child/adolescent (6 years to 18 years)(Required)
Young Adults Middle Adult (19 years to 64 years)(Required)
Older Adults/Elderly (65+years)(Required)

Genera Skills

Standard Precautions(Required)
Isolation Precautions(Required)
Pediatric Respiratory/Cardiac Arrest(Required)
Adult Respiratory/Cardiac Arrest(Required)
Crash Carts(Required)
Defi brillators(Required)
Electronic Documentation(Required)
Automated Med Dispensing Systems(Required)

BASIC SKILLS

10-20 Electrode Placement(Required)
Portable Recording in Adult ICU(Required)
Portable Recording in Pediatric ICU(Required)
Portable Recording in NICU(Required)
ECI-Brain Death Recording(Required)
Ambulatory EEG(Required)
Sleep Deprived EEG(Required)
Sleep EEG(Required)
EMG(Required)

EVOKED POTENTIALS

Somatosensory Evoked Potential (SSEP)(Required)
Motor Evoked Potential(Required)
Visual Evoked Potential(Required)
Auditory Evoked Potential(Required)
Assist with Nerve Conduction Studies/EMG(Required)

EQUIPMENT

Paper Machine Experience(Required)
Digital Machine Experience(Required)
Nicolet(Required)
Cadwell(Required)
Grass(Required)
Xltek(Required)
Nihon Kohden(Required)

DOCUMENTATION

Obtain Patient History(Required)
Changes in Patient Status(Required)
Stimulation(Required)
Hyperventilation(Required)
Post Hyperventilation(Required)
Interpreting EEG Pattern(Required)

OTHER SKILLS: