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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
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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
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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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Social Worker Annual Competency
Social Worker 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 process paperwork and associated tasks related to:
1) Self-Assessment
Proficien
Need Review
No Experience
1. Initial Evaluation
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 planning/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. Documentation per requirements
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. 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
1. Counseling for long range planning and decision making
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. Counsel and assist with out-of-home placement
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. Community resource planning and information
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. Short-term therapy related to illness
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. Evaluate home/family situation
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. Promote community services and provide education
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. Provide advocacy, referral and linkage with community services
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. Counsel and assist with financial matters
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. Assist with strengthening the family support system
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. Assist with resolution of conflict related to illness
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. Identify and advocate for patients at risk for physical or mental abuse and/or neglect
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. Identify and evaluate patients at high risk for suicide
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. Identify and evaluate patients with inadequate food, medications and/or medical supplies
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. 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
Proficien
Need Review
No Experience
3. 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
Proficien
Need Review
No Experience
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
Proficien
Need Review
No Experience
2. Emergency preparedness
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
Proficien
Need Review
No Experience
1. Education adheres to plan of 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. Evaluates effectiveness of teaching
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. 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
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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