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Nurse Practitioner Skills Checklist

Fill Out and Submit your Skills Checklist

I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Skills Checklist

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1No Experience

2Need Training

3Able to perform with supervisione

4Able to perform independently

Areas Worked

Experience With

Disorders – Emergencies

Collaboration

Respiratory

Pneumonia:

Sinusitis:

Cardiovascular System

OB/GYN

GI System

Skin

Ears, Nose and Throat

Eye

Musculoskeletal

Parasitic Infections

Genitourinary System

Nervous System

Endocrine

Hematological

Psychosocial

Drug Therapy

Knowledge of potential adverse reactions:

Dispensing Medication

Non-Pharmacologic Interventions

Miscellaneous

Programs

Age Specific Competencies

Please list any Additional Skills:

Additional training:

Additional equipment:

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Reach us

contact@selectsourceintl.com
care@selectsourceintl.com
Phone: +1-952-546-3300
Fax: +1-952-546-3500
13911 Ridgedale Drive, Suite 230
Minnetonka, Minnesota 55305, United States

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