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Neurology Clinical Skill Set


DIRECTIONS: By completing this checklist to the best of your ability, you will help us match your skills and areas of interest with our available assignments.

CONTACT INFORMATION
Name: (Required)
Email Address: (Required)
Recruiters Name:
EDUCATION
Medical School:
Residency:
Fellowship:
CERTIFICATIONS
BC: . . . . BE:
Additional Certifications:
Other Languages Spoken:
STATE LICENSE INFO
States Licensed In:
Enter State/Lic.#/Exp. Date

Please place a Check in the column that most accurately describes your level of experience with each skill.
EXPERIENCE LEVELS
4 = VERY EXPERIENCED (can perform well independently)
3 = EXPERIENCED (Need initial review, then can perform independently)
2 = SOME EXPERIENCE (Require assistance/supervision)
1 = NO EXPERIENCE
CLINICAL AREA: General Neurology - Diagnosis and management of neurological disorders, including headaches, seizures, stroke, dementia, sleep studies, movement disorders.

Pediatric: . . . 1: . . . 2: . . . 3: . . . 4:
Adult: . . . 1: . . . 2: . . . 3: . . . 4:
Inpatient: . . . 1: . . . 2: . . . 3: . . . 4:
Outpatient: . . . 1: . . . 2: . . . 3: . . . 4:
Other Clinical Areas:
PROCEDURES
Disability Evaluation: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
EEG (Electroencephalogram): . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
EMG (Electromyogram): . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
NCV (Nerve Conduction Velocity): . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Movement Disorders: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Evoked Potentials: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Brain Mapping: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Sleep Studies: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Stroke Management: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Balance Disorders: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Pain Management: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Peripheral Nerve Blocks: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Spinal/Paraspinal/Epidural Blocks: . . . 1: . . . 2: . . . 3: . . . 4:
Number Performed:
Additional Procedures:
 


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