Skills Checklist

Congratulations on your decision to apply for a Travel position with Med Travelers! Before we can offer you an employment opportunity, an electronic skills assessment must be completed. From the skills checklist below, please locate the list that matches your specialty and complete the online form. Be sure to review your information thoroughly before clicking the submit button. Thank you!

OT/COTA Skills Checklist

*

Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name*	Middle Name	Last Name*
E-Mail Address*	Phone Number*

 

 

Please mark your level of experience

1. No experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others

 

CLINICAL SETTING

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2

3

4

 

Acute Care - Adult

 

Acute Care - Pediatric

 

Home Health Care - Adult

 

Home Health Care - Pediatric

 

Long Term Acute Care (LTAC)

 

Outpatient - Adult

 

Outpatient - Pediatric

 

Psychiatric

 

Rehabilitation Facility - Adult

 

Rehabilitation Facility - Pediatric

 

School

 

Skilled Nursing Care

 

Teletherapy: (enter setting)

 

MODALITIES/MANUAL SKILLS/THERAPIES

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2

3

4

 

Aquatic Therapy

 

Biofeedback

 

Burn/Wound Management

 

Cardiac Rehabilitation

 

Community Re-entry

 

Diathermy

 

Edema Massage

 

Elastic Therapeutic Taping Techniques

 

Electrical Stimulation

 

Feeding/Swallowing

 

Fluidotherapy

 

Handwriting

 

Iontopheresis

 

Joint Mobilization

 

Manual Therapy - Soft Tissue

 

Myofascial Release

 

Paraffin Bath

 

Sensory Integration

 

Substance Abuse

 

TENS

 

Therapeutic Ultrasound

 

Vision Rehabilitation

 

EVALUATION TOOLS - ADULT/PEDIATRIC

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2

3

4

 

Assessment of Motor and Process Skills (AMPS)

 

Barthel Index and Modified Version

 

Beery-Buktenica Visual-Motor Integration (BEERY VMI)

 

Bruininks-Oseretsky Test of Motor Proficiency (BOT)

 

Canadian Occupational Performance Measure (COPM)

 

Development Test of Visual Perception (DTVP)

 

Disabilities of the Arm, Shoulder and Hand (DASH)

 

Functional Independence Measure (FIM)

 

Functional Reach

 

KATZ Index

 

Kohlman Evaluation of Living Skills (KELS)

 

Motor-Free Visual Perception Test (MVPT-III)

 

Routine Task Inventory (RTI)

 

Sensory Profile

 

Test of Visual Perceptual Skills (TVPS)

 

ADL TRAINING

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2

3

4

 

Adaptive Equipment

 

Driver's Evaluation/Education

 

Home Assessment

 

Wheelchair Evaluation & Positioning

 

VOCATIONAL TRAINING

1

2

3

4

 

Cognitive Assessment

 

Functional Capacity Evaluation

 

Job Task Analysis

 

Perceptual Assessment

 

Work Hardening

 

ORTHOPEDICS

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2

3

4

 

Arthritis - Energy Conservation

 

Arthritis - Joint Protection

 

Carpal Tunnel Syndrome

 

Cubital Tunnel Syndrome

 

DeQuervain's Tenosynovitis

 

Fractures of Wrist and Hand

 

Ganglion Cysts

 

Hip Fracture

 

Joint Replacement - Elbow

 

Joint Replacement - Hip/Knee

 

Joint Replacement - Shoulder/Reverse Shoulder

 

Joint Replacement - Wrist/Hand

 

Nerve Entrapment

 

Tendon Transfer Surgery

 

NEUROLOGIC

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2

3

4

 

ALS

 

Brain Injury

 

CVA

 

Dementia/Alzheimer's

 

Multiple Sclerosis

 

Other Progressive Neurological Disorders

 

Parkinson's Disease

 

Peripheral Nerve Injury

 

SCI

 

PROSTHETIC/ORTHOTICS

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2

3

4

 

Above/Below Knee Prosthetics

 

Dynamic Splints

 

Static Splints

 

Upper Extremity Prosthetics

 

TECHNOLOGY

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2

3

4

 

Care Manager

 

Casamba (Smart)

 

Cerner

 

Epic

 

McKesson

 

Meditech

 

Rehab Optima

 

School IEP Documentation Systems:

 

EMR Conversion

YesNo

 

Other (fill in the blank)

 

Other (fill in the blank)

 

BILLING/DOCUMENTATION

1

2

3

4

 

ICD-10 Coding: Medical Diagnosis

 

ICD-10 Coding: Treatment Diagnosis

 

Medicaid/Medical

 

Medicare Part A

 

Medicare Part B

 

OASIS

 

OT Evaluation Coding

 

Patient Driven Groupings Model (PDGM)

 

Patient Driven Payment Model (PDPM)

 

Section GG

 

PROFESSIONAL KNOWLEDGE AND SKILLS

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2

3

4

 

Concurrent Therapy

 

Group Therapy

 

Infection Prevention

 

Interdisciplinary Case Management/Case Management

 

Pain Assessment & Management

 

Screening/Adding Caseload

 

Supervisory/Management Experience

 

Age Specific

1

2

3

4

 

Neonate/Infant

 

Toddler/Preschool

 

School Age Children

 

Adolescents

 

Young/Middle Adults

 

Older Adults/Geriatrics

 

CERTIFICATIONS AND QUALIFICATIONS (Current at time of completing this form)

 

BLS

YesNo

 

Certified Hand Therapist

YesNo

 

Lymphedema Management

YesNo

 

Non Violent Crisis Intervention (e.g. CPI)

YesNo

 

Other: Specify

 

Other: Specify

OT/COTA Skills Checklist, version 9

You must agree with the statements at the bottom of the form before submitting your skills checklist.

Please read and agree to the statements below by marking the checkbox.

* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.