Medical Social Worker Skills Checklist

Medical Social Worker Skills Checklist
First Name*
Last Name*
Years of Experience*
E-mail*
example@example.com
ANSWER KEY

PROFICIENCY

1=Not Applicable 2=No Experience 3=Some Experience

4=Experienced 5=Very Experienced

FREQUENCY

1=Never Performed 2=Assisted Only 3=Rarely Performed

4=Occasionally Performed 5=Regularly Performed
Human Development, Diversity and Behavior in the Environment

Assessment / Diagnosis / Treatment Planning*

	Proficiency	Frequency
Knowledge of Effects of Environment on Client System Behavior
Assess Family / Caregiver Dynamics
Perform Cultural Assessment
Assess Support Structure
Determine Client's Eligibility for Services
Engage Client in Intake Process
Gather Client's Biopsychosocial History
Problem Identification
Assess Strengths / Challenges
Perform Risk Assessment
Assess Nature, Severity and Danger of Client's Crisis
Assess for Suspected Abuse and / or Neglect
Assessment of Mental and Behavioral Disorders
Assessment of Addictive Behaviors
Perform Community Needs Assessment
Assist Client With Community Resources
Match Intervention With Client System Needs

Clinical Interventions / Case Management

Therapeutic Relationship*

	Proficiency	Frequency
Obtain / Verify Informed Consent for Treatment
Engage Client in Treatment Plan

Intervention Process*

	Proficiency	Frequency
Develop Treatment / Service Plan for Client
Formulate Measurable and Realistic Treatment Objectives
Ability to Modify Treatment Plan
Assist Client With Grieving Process
Provide Conflict Resolution
Patient RIghts Advocate
Coordinate Care With Pharmaceutical Prescriber and Provider
Provide Case Management Services

Consultation and Interdisciplinary Collaboration*

	Proficiency	Frequency
Facilitate Referral Process as Needed
Follow up on Referrals
Participate in Case Conferences
Conduct Court-Ordered Evaluations
Conduct Custody Evaluations

Professional Ethics / Values

Clinical Components*

	Proficiency	Frequency
Identification and Resolution of Ethical Dilemmas
Documentation of Ethical Issues
Mandatory Reporting Requirements of Ethical Issues
Understand Legal and Ethical Issues Related to Confidentiality
Protect and Augment Client Self-Determination

Units Worked

Units Worked*

	Proficiency	Frequency
ICU
PCU
Telemetry
Med Surg
ER
LD/OB
PEDS
PICU
Oncology
PACU
Skilled Nursing
Dialysis
Psych

Supervision

Ability to*

	Proficiency	Frequency
Understand Roles and Responsibilities of Other Healthcare Professionals and Support Staff
Function in Supervisory Capacity

Age Specific Criteria*

	Proficiency	Frequency
Newborn / Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

Background Experience*

	Proficiency	Frequency
Small Hospital
Large Hospital
Outpatient
Acute Care / Hospital
Cancer Center
Clinic
Managed Care
SNF / Long Term Care
Home Health

The information provided is true and to the best of my knowledge. I hereby authorize Summit Medical Staffing to present my Skills Checklist to facilities for the purpose of employment. Please Type Your Name in This Box to Electronically Sign this Form.*

First NameLast Name
Date*

MonthDayYear
Hour MinutesAM/PM Option
Form Reply Email Address
Salesforce Check
Should be Empty: