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Home
About
Services
Skilled Medical Services
Prescription Refill and Management
Open Wound Dressing
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Speech fluency/ articulation
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Short/long term planning of care
Adequate clients follow up
Home Health Aide
Medication reminders
Personal Care; Bed bath, using lift.
Vital signs monitoring & Report to Clinical Nurse
Certain housekeeping
Safety Supervision during Seizure
Symptom monitor and report to Clinical Nurse
Mobility support
Physical Occupational Therapy
Restore Function
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Control disabilities
Balancing & Gait
Promote ADL functions
Create an exercise plan
Promote Overall fitness
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
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Occupational Therapist Initial Competency
Occupational Therapist Initial Competency
Scroll
Name
(Required)
Date of Hire
(Required)
MM slash DD slash YYYY
Date Completed
(Required)
MM slash DD slash YYYY
Demonstrates ability to process paperwork and associated tasks related to:
1) Self-Assessment
Proficien
Need Review
No Experience
1. Initial Evaluation
Initial therapy evaluation
Develops care plan based on assessment
Health history/physical exam
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficien
Need Review
No Experience
2. OASIS Documentation
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficien
Need Review
No Experience
3. Care coordination/discharge planning
Care planning
Care coordination
Case management
Documents and reports key information to physician, RN Case Manager, supervisor, care team
Coordinates community resources
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficien
Need Review
No Experience
4. Transfer of patient
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficien
Need Review
No Experience
5. Documentation
CMS/state guidelines for documentation
Adheres to plan of care
Corrections to the clinical record
Accident/incident reports
Clinical notes
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficien
Need Review
No Experience
6. Other
Supervision of ancillary personnel
Supply and DME management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Assessment/Evaluation:
1) Self-Assessment
Proficien
Need Review
No Experience
1. Mental Status/Cognition/Communication
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficien
Need Review
No Experience
2. Upper Extremity (ROM, strength, coordination)
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficien
Need Review
No Experience
3. Balance/trunk control
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficien
Need Review
No Experience
4. Ambulation/endurance
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficien
Need Review
No Experience
5. Transfers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficien
Need Review
No Experience
6. Visual/sensory/perceptual performance
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficien
Need Review
No Experience
7. Functional
Eating/feeding
Dressing
Hygiene
Toileting
Cooking/laundry/cleaning/home skills
Writing/phone use
Leisure interests
Time use and structuring
Medication management
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
8) Self-Assessment
Proficien
Need Review
No Experience
8. Environment evaluation / barriers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
9) Self-Assessment
Proficien
Need Review
No Experience
9. Equipment/assistive device needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
10) Self-Assessment
Proficien
Need Review
No Experience
10. Evaluate/recommend home modifications
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
11) Self-Assessment
Proficien
Need Review
No Experience
11. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Skilled Treatments/Interventions:
1) Self-Assessment
Proficien
Need Review
No Experience
12. Community/work integration
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficien
Need Review
No Experience
2. Neuromuscular re-education
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficien
Need Review
No Experience
3. Fall prevention/safety
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficien
Need Review
No Experience
4. Postural control training
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
MM slash DD slash YYYY
5) Self-Assessment
Proficien
Need Review
No Experience
5. Safe use of equipment/devices training
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficien
Need Review
No Experience
6. Self-care management training
ADLs/IADLs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficien
Need Review
No Experience
7. Energy conservation techniques
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
8) Self-Assessment
Proficien
Need Review
No Experience
8. Breathing techniques
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
9) Self-Assessment
Proficien
Need Review
No Experience
9. Cognitive skills development/training
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
10) Self-Assessment
Proficien
Need Review
No Experience
10. Manual therapy techniques
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
11) Self-Assessment
Proficien
Need Review
No Experience
11. Sensory integrative techniques
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
12) Self-Assessment
Proficien
Need Review
No Experience
12. Community/work integration
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
13) Self-Assessment
Proficien
Need Review
No Experience
13. Fine motor/dexterity/gross motor training
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
14) Self-Assessment
Proficien
Need Review
No Experience
14. Pain assessment and management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
15) Self-Assessment
Proficien
Need Review
No Experience
15. Miscellaneous Skills
ital signs
Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
16) Self-Assessment
Proficien
Need Review
No Experience
16. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Use of Equipment/Modalities:
1) Self-Assessment
Proficien
Need Review
No Experience
1. Ultrasound
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficien
Need Review
No Experience
2. Hot/cold packs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficien
Need Review
No Experience
3. TENS/FES
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficien
Need Review
No Experience
4. Orthotics/Splints/Immobilizers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficien
Need Review
No Experience
5. Pulse oximeter
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficien
Need Review
No Experience
6. Massage
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficien
Need Review
No Experience
7. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Infection Control
1) Self-Assessment
Proficien
Need Review
No Experience
1. Hand hygiene technique
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficien
Need Review
No Experience
2. Proper bag technique
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
3. Personal protective equipment
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
4. Exposure control plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
5. TB exposure control plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
6. Reporting of infections for patient and personnel
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
7) Self-Assessment
Proficient
7. Standard precautions
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Safety
1) Self-Assessment
Proficient
1. Assessment of patient safety risks and home safety
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
2. Emergency preparedness
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
3. Fire extinguishers
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
4. Hazardous materials
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Patient Education
1) Self-Assessment
Proficient
1. Determines patient / family learning needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
2) Self-Assessment
Proficient
2. Sets measurable objectives
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
3) Self-Assessment
Proficient
3. Develops/implements teaching plan
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
4) Self-Assessment
Proficient
4. Evaluates effectiveness of teaching
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
5) Self-Assessment
Proficient
5. Revises teaching plan based on patient needs
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
6) Self-Assessment
Proficient
6. Documents response to teaching
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Other
Search for:
Home
About
Services
Skilled Medical Services
Prescription Refill and Management
Open Wound Dressing
Ostomy Care
Catheter Care
G-Tube Feeding
Vital Signs Monitoring And Report To PCP Doctor
Safety Supervision
Symptom Monitoring
Mobility Support
Speech Therapy
Evaluation/Diagnosis/Prevention of speech impairment
Swallow evaluation and management
Speech fluency/ articulation
Cognitive communication
Medical Social Worker
Providing adequate resources for clients in the community
Short/long term planning of care
Adequate clients follow up
Home Health Aide
Medication reminders
Personal Care; Bed bath, using lift.
Vital signs monitoring & Report to Clinical Nurse
Certain housekeeping
Safety Supervision during Seizure
Symptom monitor and report to Clinical Nurse
Mobility support
Physical Occupational Therapy
Restore Function
Improve Mobility & Strength
Aid inside/outside ambulation
Range of motion, Positioning & Transfers
Control disabilities
Balancing & Gait
Promote ADL functions
Create an exercise plan
Promote Overall fitness
Forms
Administrator Competency & Job Description Form
Clinical Manager Job Description Form
Home Health Aide Competency & Job Description & Skill Validation
LPN Competency Job Description Form
MSW Competency Job Description Form
Occupational Therapist Assistant Job Description Form
Occupational Therapist Job Description Form
Physical Therapist Assistant Job Description Form
Physical Therapist Job Description Form
RN Job Description & Performance Evaluation & Competency Form
Speech Therapist Job Description Form
Resources
Employement
SanData
EVV
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