OUR SERVICES


Management
Search


Interim
Management


Physician Services &
Advanced Practice


Radiation Oncology &
Oncology Services


Mission Search
Direct


Physics Support
Services


Medical Claims
Processing


Employee Login



Nurse Practitioner/Physician Assistant
Skills Checklist

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. 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

CONTACT INFORMATION
Name: (Required)
Email Address:
Recruiters Name:
CERTIFICATIONS

ALS: . . . . BLS: . . . . CPR: . . . .
Additional Certifications:
Other Languages Spoken:
STATE LICENSE INFO
States Licensed In:
Enter State/Lic.#/Exp. Date
SPECIALTY:
Anesthesiology: . . . 1: . . . 2: . . . 3: . . . 4:
Cardiology: . . . 1: . . . 2: . . . 3: . . . 4:
Corporate Health: . . . 1: . . . 2: . . . 3: . . . 4:
Critical Care: . . . 1: . . . 2: . . . 3: . . . 4:
Dermatology: . . . 1: . . . 2: . . . 3: . . . 4:
Emergency Medicine: . . . 1: . . . 2: . . . 3: . . . 4:
Ears, Nose, and Throat: . . . 1: . . . 2: . . . 3: . . . 4:
Correctional Care: . . . 1: . . . 2: . . . 3: . . . 4:
Family Practice: . . . 1: . . . 2: . . . 3: . . . 4:
Genetics: . . . 1: . . . 2: . . . 3: . . . 4:
Forensic Medicine: . . . 1: . . . 2: . . . 3: . . . 4:
Internal Medicine: . . . 1: . . . 2: . . . 3: . . . 4:
Interventional Radiology: . . . 1: . . . 2: . . . 3: . . . 4:
Substance Abuse: . . . 1: . . . 2: . . . 3: . . . 4:
Ob and Gynecology: . . . 1: . . . 2: . . . 3: . . . 4:
Occupational Medicine: . . . 1: . . . 2: . . . 3: . . . 4:
Ophthalmology: . . . 1: . . . 2: . . . 3: . . . 4:
Pain Medicine: . . . 1: . . . 2: . . . 3: . . . 4:
Pathology: . . . 1: . . . 2: . . . 3: . . . 4:
Peds: . . . 1: . . . 2: . . . 3: . . . 4:
Physical Med/Rehab: . . . 1: . . . 2: . . . 3: . . . 4:
Psychiatry: . . . 1: . . . 2: . . . 3: . . . 4:
Public Health: . . . 1: . . . 2: . . . 3: . . . 4:
Radiation Oncology: . . . 1: . . . 2: . . . 3: . . . 4:
Surgery: . . . 1: . . . 2: . . . 3: . . . 4:
Non Clinical: . . . 1: . . . 2: . . . 3: . . . 4:
Additional Specialty:
DISORDERS-EMERGENCIES:
Anaphylaxis: . . . 1: . . . 2: . . . 3: . . . 4:
Cardiac arrest: . . . 1: . . . 2: . . . 3: . . . 4:
Seizures: . . . 1: . . . 2: . . . 3: . . . 4:
Minor head injuries: . . . 1: . . . 2: . . . 3: . . . 4:
Animal bites: . . . 1: . . . 2: . . . 3: . . . 4:
Ingestions and poisonings: . . . 1: . . . 2: . . . 3: . . . 4:
Overdose - sedative, hypnotics: . . . 1: . . . 2: . . . 3: . . . 4:
Snake bites: . . . 1: . . . 2: . . . 3: . . . 4:
Minor burns: . . . 1: . . . 2: . . . 3: . . . 4:
Shock: . . . 1: . . . 2: . . . 3: . . . 4:
Open wounds: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
RESPIRATORY:
Croup: . . . 1: . . . 2: . . . 3: . . . 4:
Influenza: . . . 1: . . . 2: . . . 3: . . . 4:
Tracheobronchitis: . . . 1: . . . 2: . . . 3: . . . 4:
Bronchitis: . . . 1: . . . 2: . . . 3: . . . 4:
COPD: . . . 1: . . . 2: . . . 3: . . . 4:
Asthma: . . . 1: . . . 2: . . . 3: . . . 4:
Pneumonia: . . . 1: . . . 2: . . . 3: . . . 4:
Viral: . . . 1: . . . 2: . . . 3: . . . 4:
Bacterial: . . . 1: . . . 2: . . . 3: . . . 4:
Nonbacterial: . . . 1: . . . 2: . . . 3: . . . 4:
URI (Upper respiratory infection): . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
CARDIOVASCULAR SYSTEM:
Congestive heart failure: . . . 1: . . . 2: . . . 3: . . . 4:
Chronic obstructive pulmonary disease: . . . 1: . . . 2: . . . 3: . . . 4:
Stasis ulcer of lower extremities: . . . 1: . . . 2: . . . 3: . . . 4:
Angina: . . . 1: . . . 2: . . . 3: . . . 4:
Pericarditis: . . . 1: . . . 2: . . . 3: . . . 4:
Coronary artery disease: . . . 1: . . . 2: . . . 3: . . . 4:
Functional murmurs: . . . 1: . . . 2: . . . 3: . . . 4:
Congenital heart disease: . . . 1: . . . 2: . . . 3: . . . 4:
Hypertension . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
OB/GYN:
Nausea/vomiting - pregnancy: . . . 1: . . . 2: . . . 3: . . . 4:
Dysmenorrhea: . . . 1: . . . 2: . . . 3: . . . 4:
Candida vaginitis: . . . 1: . . . 2: . . . 3: . . . 4:
Pap smears: . . . 1: . . . 2: . . . 3: . . . 4:
Abnormal pap smear findings: . . . 1: . . . 2: . . . 3: . . . 4:
Trichomonal Vaginitis: . . . 1: . . . 2: . . . 3: . . . 4:
Atrophic vaginitis: . . . 1: . . . 2: . . . 3: . . . 4:
Fibrocystic breast disease: . . . 1: . . . 2: . . . 3: . . . 4:
Menopause: . . . 1: . . . 2: . . . 3: . . . 4:
Bartholin’s cyst/ abscess: . . . 1: . . . 2: . . . 3: . . . 4:
Preparation for childbirth: . . . 1: . . . 2: . . . 3: . . . 4:
Pregnancy-diagnosis: . . . 1: . . . 2: . . . 3: . . . 4:
Pain relief (in active phase of labor): . . . 1: . . . 2: . . . 3: . . . 4:
Intrapartum medications: . . . 1: . . . 2: . . . 3: . . . 4:
Medications in the third stage: . . . 1: . . . 2: . . . 3: . . . 4:
Dysfunctional uterine bleeding: . . . 1: . . . 2: . . . 3: . . . 4:
Rh blood factor: . . . 1: . . . 2: . . . 3: . . . 4:
Mastitis: . . . 1: . . . 2: . . . 3: . . . 4:
Medications in the Post Partum : . . . 1: . . . 2: . . . 3: . . . 4:
Birth control methods: . . . 1: . . . 2: . . . 3: . . . 4:
Pre-natal care: . . . 1: . . . 2: . . . 3: . . . 4:
Fetal well-being: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
GI system:
Constipation: . . . 1: . . . 2: . . . 3: . . . 4:
Diarrhea (simple): . . . 1: . . . 2: . . . 3: . . . 4:
Irritable bowel syndrome: . . . 1: . . . 2: . . . 3: . . . 4:
Acute gastroenteritis: . . . 1: . . . 2: . . . 3: . . . 4:
Hiatal hernia: . . . 1: . . . 2: . . . 3: . . . 4:
Hemorrhoids: . . . 1: . . . 2: . . . 3: . . . 4:
Hepatitis: . . . 1: . . . 2: . . . 3: . . . 4:
Duodenal ulcer: . . . 1: . . . 2: . . . 3: . . . 4:
Cholecystitis: . . . 1: . . . 2: . . . 3: . . . 4:
Pyloric stenosis: . . . 1: . . . 2: . . . 3: . . . 4:
Colic: . . . 1: . . . 2: . . . 3: . . . 4:
Appendicitis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Skin:
Warts: . . . 1: . . . 2: . . . 3: . . . 4:
Basal skin carcinoma: . . . 1: . . . 2: . . . 3: . . . 4:
Scabies: . . . 1: . . . 2: . . . 3: . . . 4:
Impetigo: . . . 1: . . . 2: . . . 3: . . . 4:
Diaper dermatitis: . . . 1: . . . 2: . . . 3: . . . 4:
Acne: . . . 1: . . . 2: . . . 3: . . . 4:
Folliculitis: . . . 1: . . . 2: . . . 3: . . . 4:
Furuncles: . . . 1: . . . 2: . . . 3: . . . 4:
Carbuncles: . . . 1: . . . 2: . . . 3: . . . 4:
Herpes simples: . . . 1: . . . 2: . . . 3: . . . 4:
Herpes zoster: . . . 1: . . . 2: . . . 3: . . . 4:
Malignant melanoma: . . . 1: . . . 2: . . . 3: . . . 4:
Pityriasis Rosea: . . . 1: . . . 2: . . . 3: . . . 4:
Contact dermatitis: . . . 1: . . . 2: . . . 3: . . . 4:
Tinea corporis: . . . 1: . . . 2: . . . 3: . . . 4:
Tinea pedis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Ears, Nose, and Throat:
Epistaxis: . . . 1: . . . 2: . . . 3: . . . 4:
Otitis externa: . . . 1: . . . 2: . . . 3: . . . 4:
Serous otitis media: . . . 1: . . . 2: . . . 3: . . . 4:
Acute purulent Otitis media: . . . 1: . . . 2: . . . 3: . . . 4:
Allergic rhinitis: . . . 1: . . . 2: . . . 3: . . . 4:
Pharyngitis: . . . 1: . . . 2: . . . 3: . . . 4:
Oral candidiasis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Eye:
Conjunctivitis: . . . 1: . . . 2: . . . 3: . . . 4:
Strabismus: . . . 1: . . . 2: . . . 3: . . . 4:
Chalazion: . . . 1: . . . 2: . . . 3: . . . 4:
Stye: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Musculoskeletal:
Osteoporosis: . . . 1: . . . 2: . . . 3: . . . 4:
Osteomyelitis: . . . 1: . . . 2: . . . 3: . . . 4:
Rheumatoid arthritis: . . . 1: . . . 2: . . . 3: . . . 4:
Juvenile diabetes: . . . 1: . . . 2: . . . 3: . . . 4:
Gout: . . . 1: . . . 2: . . . 3: . . . 4:
Minor sprains and strains: . . . 1: . . . 2: . . . 3: . . . 4:
Osteoarthritis: . . . 1: . . . 2: . . . 3: . . . 4:
Carpal tunnel syndrome: . . . 1: . . . 2: . . . 3: . . . 4:
Scoliosis: . . . 1: . . . 2: . . . 3: . . . 4:
Tendonitis: . . . 1: . . . 2: . . . 3: . . . 4:
Bursitis: . . . 1: . . . 2: . . . 3: . . . 4:
Muscular dystrophy: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Parasitic Infections:
Pinworms: . . . 1: . . . 2: . . . 3: . . . 4:
Ascariasis: . . . 1: . . . 2: . . . 3: . . . 4:
Pediculosis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Genitourinary System:
Syphilis: . . . 1: . . . 2: . . . 3: . . . 4:
Chlamydia: . . . 1: . . . 2: . . . 3: . . . 4:
Herpes: . . . 1: . . . 2: . . . 3: . . . 4:
Cystitis: . . . 1: . . . 2: . . . 3: . . . 4:
Pyelonephritis: . . . 1: . . . 2: . . . 3: . . . 4:
Urinary tract infection: . . . 1: . . . 2: . . . 3: . . . 4:
Benign prostatic hypertrophy: . . . 1: . . . 2: . . . 3: . . . 4:
Vulvovaginitis: . . . 1: . . . 2: . . . 3: . . . 4:
Hypospadias: . . . 1: . . . 2: . . . 3: . . . 4:
Hydrocele: . . . 1: . . . 2: . . . 3: . . . 4:
Gonococcal infections: . . . 1: . . . 2: . . . 3: . . . 4:
Prostatitis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Nervous System:
Vasovagal syncope: . . . 1: . . . 2: . . . 3: . . . 4:
Migraine headaches: . . . 1: . . . 2: . . . 3: . . . 4:
Multiple sclerosis: . . . 1: . . . 2: . . . 3: . . . 4:
Headaches: . . . 1: . . . 2: . . . 3: . . . 4:
Head injury: . . . 1: . . . 2: . . . 3: . . . 4:
Tension: . . . 1: . . . 2: . . . 3: . . . 4:
Migraine: . . . 1: . . . 2: . . . 3: . . . 4:
Anxiety: . . . 1: . . . 2: . . . 3: . . . 4:
Parkinson’s: . . . 1: . . . 2: . . . 3: . . . 4:
Bell’s Palsy: . . . 1: . . . 2: . . . 3: . . . 4:
TIA (transient ischemic attacks): . . . 1: . . . 2: . . . 3: . . . 4:
Trigeminal neuralgia: . . . 1: . . . 2: . . . 3: . . . 4:
Multiple sclerosis: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Endocrine:
Type I diabetes mellitus: . . . 1: . . . 2: . . . 3: . . . 4:
Type II diabetes mellitus: . . . 1: . . . 2: . . . 3: . . . 4:
Graves disease: . . . 1: . . . 2: . . . 3: . . . 4:
Addison’s disease: . . . 1: . . . 2: . . . 3: . . . 4:
Juvenile diabetes: . . . 1: . . . 2: . . . 3: . . . 4:
Hypoglycemia: . . . 1: . . . 2: . . . 3: . . . 4:
Hypothyroidism: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Hematological:
Folic acid deficiency anemia: . . . 1: . . . 2: . . . 3: . . . 4:
Aplastic anemia: . . . 1: . . . 2: . . . 3: . . . 4:
Iron deficiency: . . . 1: . . . 2: . . . 3: . . . 4:
Sickle cell anemia: . . . 1: . . . 2: . . . 3: . . . 4:
Pernicious anemia: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Psychosocial:
Depression: . . . 1: . . . 2: . . . 3: . . . 4:
Suicide: . . . 1: . . . 2: . . . 3: . . . 4:
Obesity: . . . 1: . . . 2: . . . 3: . . . 4:
Grief: . . . 1: . . . 2: . . . 3: . . . 4:
Anxiety: . . . 1: . . . 2: . . . 3: . . . 4:
Anorexia: . . . 1: . . . 2: . . . 3: . . . 4:
Bulimia: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Miscellaneous:
Suturing: . . . 1: . . . 2: . . . 3: . . . 4:
Cell biopsy: . . . 1: . . . 2: . . . 3: . . . 4:
Starting IV: . . . 1: . . . 2: . . . 3: . . . 4:
Casting and splinting: . . . 1: . . . 2: . . . 3: . . . 4:
Other (list):
Age Specific Competency: Able to ensure a safe and caring environment for the specific age groups indicated below; communicate and instruct patients from various age groups; able to evaluate age-appropriate able to behavior and skills.
Newborn
(birth-30 days):		 . . . 1: . . . 2: . . . 3: . . . 4:
Infant
(30 days-1 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Toddler
(1-3 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Preschooler
(3-5 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
School Age
(5-12 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Adolescents
(12-18 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Young Adults
(18-39 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Middle Adults
(39-64 yrs):		 . . . 1: . . . 2: . . . 3: . . . 4:
Older Adults
(64 yrs +):		 . . . 1: . . . 2: . . . 3: . . . 4:

The information represented above is true and correct to the best of my knowledge. I also authorize Mission Search Healthcare to share the above skills checklist with its clients.
 


Sitemap
Mission Search International 2203 N. Lois Ave. #1225 Tampa, FL 33607 (800) 410-2009 Fax: (813) 870-9051
EMail: Info@MissionSearchUSA.com Website: MissionSearchUSA.com

© Mission Search International, All rights reserved.