Requested by *Recruiter Email ID *First Name *Last Name *Phone Number *Today's Date *Your Email Address *WORK SETTING EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Procedural Cath Lab *012345Interventional Cath Lab *012345Interventional Radiology *012345Pre/Post Setting *012345EP Lab *012345GENERAL SKILLS:Rank each of the following sections on a scale of 1 to 3:: Limited or no experience Experienced, but may need review or supervision Able to function independently * Experienced in diagnostic catheterizations *012345Experienced in interventional catheterizations *012345Automated Medication Dispensing System, Pyxis, Omnicell, or other *012345Awareness of HCAHPS *012345GENERAL SKILLS - PHYSIOLOGIC MONITORING:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Monitoring / recording of LHC/RHC *012345Monitoring / recording of aortic / mitral valve cases *012345Monitoring / recording of PCI (Percutaneous Coronary Interventions) *012345Monitoring / recording valve cases *012345Monitoring / recording ASD closures *012345Monitoring / recording of EP / ablation cases *012345Monitoring / recording of permanent pacemaker insertions *012345National Patient Safety Goals *012345Accurate patient identification *012345Effective communication *012345Interpretation & communication of lab values *012345Medication administration *012345Medication reconciliation *012345Labeling (medications & specimens) *012345Anticoagulation therapy *012345Monitoring conscious sedation *012345Pain assessment & management *012345Infection control *012345Universal precautions *012345Isolation *012345Minimize risk for falls *012345Prevention of pressure ulcers *012345Use of rapid response teams *012345GENERAL SKILLS - CIRCULATES:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * LHC/RHC *012345IABP insertions *012345FFR (radi wire) *012345IVUS/volcano *012345Thrombectomies *012345Valvuloplasty *012345ASD closures *012345Atherectomy *012345Filter wires *012345Embolic protection devices *012345EP/ablationsRank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Permanent pacemaker insertions *012345Places leads & pads for cardiac mapping *012345Electronic charting *012345Time Out Protocol *012345GENERAL SKILLS - SCRUBS:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * LHC/RHC *012345IABP insertions *012345Filter wires *012345Embolic protection devices *012345ASD closures *012345Valvuloplasty *012345Atherectomy *012345PCI *012345EP/ablations *012345Permanent pacemaker insertions *012345Maintain temporary pacemaker *012345GENERAL SKILLS - EQUIPMENTRank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Hemochron *012345ABG analysis machines *012345Laser *012345Power injectors *012345INTERVENTIONAL RADIOLOGY RN EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Circulates for interventional procedures *012345Scrubs for interventional procedures *012345Angiogram / aortogram *012345Angioplasty *012345Vascular stenting *012345Declotting *012345Embolization *012345TIPS *012345Port placement *012345Dialysis catheter placement *012345Retrieval of foreign body *012345UAE (Uterine Arterial Embolization) *012345EVLT (Endovascular Laser Therapy) *012345Vertebro / kyphoplasty *012345Neuroradiology *012345Discogram *012345AAA endograft repair *012345Carotids *012345Extremities *012345AGE-SPECIFIC EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Newborn / neonate (birth-30 days) *012345Infant (31 days-1 year) *012345Toddler (ages 2-3 years) *012345Preschool (ages 4-5 years) *012345School age (ages 6-12 years) *012345Adolescent (ages 13-21 years) *012345Young adult (ages 22-39 years) *012345Adult (ages 40-64 years) *012345Older adult (ages 65-79 years) *012345Elderly (ages 80+ years) *012345Attestation * I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years. If you agree with the Attestation above, please electronically sign your name. *Request Quote