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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
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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
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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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Speech Therapist Annual Competency
Speech Therapist 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. 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 planning/coordination
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. Case management
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 per requirements
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. Supervision of ancillary personnel
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. Therapeutic activities
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. Speech articulation disorders
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
3) Self-Assessment
Proficien
Need Review
No Experience
3.Language disorders
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. Non-verbal communication
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.Language processing
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. Therapy to increase articulation, proficiency, verbal expression
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. Dysphagia instruction/treatments
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. Develop/teach communication system
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. Voice disorders
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. Aural rehabilitation
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. Alaryngeal speech skills
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. Food texture recommendationsrs
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. Swallow/vocal skills exercises
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. Care of voice prosthesis
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. Tracheostomy care/management education
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. Pain assessment/management
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
17) Self-Assessment
Proficien
Need Review
No Experience
17. Safety/fall prevention
Eval Method
Verbal Test
Written Test
Demo
Competent
Yes
No
Preceptor Initials
(Required)
Date
(Required)
MM slash DD slash YYYY
18) Self-Assessment
Proficien
Need Review
No Experience
18. 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. NMES
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. 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
Date
MM slash DD slash YYYY
Supervisor Signature
Date
MM slash DD slash YYYY
Preceptor Signature
Date
MM slash DD slash YYYY
Preceptor Signature
Date
MM slash DD slash YYYY
Preceptor Signature
Date
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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