SELF EVALUATION
CT SKILLS PROFICIENCY CHECKLIST
| Print this form and fax or mail: Fax to: (505) 797-3822 Mail to: 5150 San Francisco RD NE Albuquerque, NM 87109 |
Last Name:
First Name:
Middle Initial:
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Years Experience: yrs. |
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DIRECTIONS: Place an x in the box that best describes your level of proficiency for each of the skills presented.
LEVELS OF PROFICIENCY KEY:
| HP = |
H ighly Proficient.Extensively experienced; able to supervise and/or train others. |
SE = |
Some Experience. |
|
| VE = |
Very Experienced. |
NE = | No Experience. | |
| EX = |
Experienced. |
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| ROUTINE STUDIES: | HP | VE | EX | SE | NE | HP | VE | EX | SE | NE | ||
| Brain with Contrast | Abdomen | |||||||||||
| Brain without Contrast | Liver | |||||||||||
| TMJ’s | Renal | |||||||||||
| Temporal Bones | Hemangioma | |||||||||||
| Orbits | Pancreas | |||||||||||
| Sinuses | Pelvis | |||||||||||
| Sella | Calculus | |||||||||||
| Facial Bones | Upper Extremities | |||||||||||
| Neck (ST) | Lower Extremities | |||||||||||
| Larynx | Cervical Spine | |||||||||||
| Chest | Thoracic Spine | |||||||||||
| Pulmonary Embolism | Lumbar Spine | |||||||||||
| HARDWARE: | HP | VE | EX | SE | NE | PRESSURE INJECTORS: | HP | VE | EX | SE | NE | |
| GE | Medrad | |||||||||||
| Hilight Advantage | L/F | |||||||||||
| Highspeed Advantage | Venipuncture | |||||||||||
| Pro Speed | ||||||||||||
| CT/I | SPECIAL PROCEDURES: | HP | VE | EX | SE | NE | ||||||
| Light Speed CT/I | Biopsy Procedures | |||||||||||
| Siemens | Angio | |||||||||||
| Picker | Stereotactic Brain | |||||||||||
| Toshiba | Bone Marrow Density | |||||||||||
Submitted by: Date:
© Rapid Temps, Inc., rev 12-99
