Skills Checklist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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Work Settings

Rows	0	1	2	3	4
General Clinic >5 MDs Practice
MD Office <5 MDs Practice
General Internal Medicine
HIV/Infection Control
Oncology Practice
Orthopedic Practice
Health/Wellness Screening
Occupational Health
Pediatric Practice
OB/GYN Practice
Surgical Practice
Utilization Review/Case Management

Vital Signs and Lab Tests

Rows	0	1	2	3	4
Height/Weight
Vital Signs - B/P, Temp/ Pulse
Snellen Eye Exam
Audiometry
12 Lead ECG
Blood Glucose via Glucometer
HbA1c
Urinalysis
Pregnancy
Strep

Injections

Rows	0	1	2	3	4
Immunization Records
Intramuscular
Subcutaneous
Intradermal

Administrative Skills

Rows	0	1	2	3	4
Schedule and Manage Appointment
Initiate Patient Medical Record
Update and File Medical Records
Electronic Documentation
Implement Referrals (Social Work, Home Health, etc.)

Office Skills

Rows	0	1	2	3	4
Date Entry
Answering Phones
Billing Entry
ICD-10 Coding
CPT Coding
Insurance Billing

Fundamental Skills

Rows	0	1	2	3	4
Clean Equipment
Order and Stock Supplies
Wrap Items for Autoclaving
Perform Sterilization Techniques
Dispose of Biohazard Materials
Practice Standard Precautions
Assist with Time Out
Practice Isolation Precautions

Diagnostic Testing Skills

Rows	0	1	2	3	4
Perform Urinalysis
Perform Hematology Testing
Perform Chemistry Testing
Perform Immunology Testing
Perform Microbiology Testing
Perform EKGs
Perform Respiratory Testing

Specimen Collection

Rows	0	1	2	3	4
Perform Venipuncture
Perform Capillary Puncture
Obtain Throat Specimen
Perform Wound Collection Procedure
Instruct Patient in the Collection of a Clean-Catch Midstream Urine Specimen
Instruct Patient in the Collection of Stool Specimen

Patient Care and Education

Rows	0	1	2	3	4
Perform Telephone and In-Person Screening
Obtain Vital Signs
Obtain and Record Patient History
Prepare/Maintain Examination and Treatment Areas
Prepare Patient for and Assist with Procedures, Treatments, and Minor Office Surgery
Prepare and Administer Medications/Immunizations
Maintain Medication and Immunization Records
Placement and Reading of PPD
Perform Suture Removal
Insertion of Urinary Catheter
Perform Pain Assessment
Apply Pulse Oximeter
Apply Pulse Oximeter
Perform Nasopharyngeal Suctioning
Utilize Transfer Assistive Devices
Utilize Glucometer
Perform Vision Screening
Perform Hearing Screening
Instruct Individuals According to their Needs and Learning Styles
Instruct and Demonstrate the Use and Care of Patient Equipment
Provide Instruction for Health Maintenance and Disease Prevention
Provide Instruction for Medications/Immunizations
Provide Instruction for Treatment and Procedures
Provide Education for Specific Conditions

Age

Rows	0	1	2	3	4
Newborn (birth-30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39 - 64 years)
Older Adults (64+ years)

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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Skills Checklist- Medical Assistant