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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
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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Registered Nurse Annual Competency
Registered Nurse Annual Competency
Scroll
Name
(Required)
Date of Hire
(Required)
MM slash DD slash YYYY
Date Completed
(Required)
MM slash DD slash YYYY
Demonstrates ability to obtain and document appropriate age specific history/assessment for patients and provide skilled nursing procedures in the following categories:
1) Self-Assessment
Proficien
Need Review
No Experience
1. OASIS/Non-OASIS documentation
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. Care 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. discharge planning
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. Demonstrates understanding of role/responsibility for Case Management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Demonstrates nursing skills:
1) Self-Assessment
Proficien
Need Review
No Experience
1.Tracheostomy care
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. Oxygen administration
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. Pharyngeal suction
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. NG tube insertion/care
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. Gastric tube feedings and care
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. Gastric tube removal
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.Ostomy care
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. Enema
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. Urinary catheters
(Required)
Foley insertion and care (male and female)
Suprapubic catheter insertion/care
Irrigation
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. Wound Care
(Required)
Aseptic Technique
Sterile Technique
Wound Vac / PICO
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. Suture/staple removal
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. Pain assessment and management
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. Other
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Medication Administration: Demonstrates ability to administer, monitor and document medications for patients.
1) Self-Assessment
Proficien
Need Review
No Experience
1. Medication Administration Techniques
(Required)
Intramuscular
Subcutaneous
Total Parenteral Nutrition
Suppositories
Anticoagulant therapy
Insulin administration, site rotation
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. Intravenous Therapy
(Required)
Administer fluids/medications
Blood draw
Site care
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.Venipuncture
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. Aseptic technique
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. Proper Bag Technique
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. Standard precautions
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Equipment
1) Self-Assessment
Proficien
Need Review
No Experience
1. Home Glucose Monitoring:
Specimen collection
Quality control process
Test correctly performed and interpreted
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. PT/INR Testing:
Specimen collection
Quality control process
Test correctly performed and interpreted
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
Comments
Employee Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Supervisor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Preceptor Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
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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