SELF EVALUATION
VASCULAR TECHNOLOGY
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: 
 Years Experience

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 =

Highly Proficient.
Extensively experienced; able to supervise and/or train others.

 SE =

Some Experience.
Need review and assistance or supervision.
VE =

Very Experienced.
Can perform well without assistance or supervision.

 NE = No Experience.
EX =

Experienced.
Competent; can perform independently; may need initial review or supervision.
PROFICIENCY LEVEL PROFICIENCY LEVEL
VASCULAR SKILLS: HP VE EX SE NE HP VE EX SE NE
Carotids Area for Percent Stenosis
Plethysmography Diameter for Percent Stenosis
Abdominal Aorta PW/CW for Percent Stenosis
Hepatic PVR
Splenic IPG
Resistive Index Abdominal Doppler
Pulsatility Index Penile Doppler
SMA Venous Duplex: Lower Extremities
Renals Venous Duplex: Upper Extremities
Segmental Pressures Arterial Doppler: Lower Extremities
TCD Arterial Doppler: Upper Extremities
OTHER AREAS OF SKILL: HP VE EX SE NE EQUIPMENT USED: HP VE EX SE NE 
Submitted by:      Date: 
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