CYNET_SYSTEMS_MAIN_LOGO.gif   Cardiac Echo Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group 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.  
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: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) WORK SETTINGS 1 2 3 4  
Adult Acute Care  
ED/ICU  
Adult Outpatient  
Pediatric Acute Care  
Pediatric Outpatient  
Rating Stars (Click) ADULT ECHO 1 2 3 4  
Routine  
3-D Echo  
Pedoff Probe  
Transesophageal Echo  
Stress Echo  
Pharmacologic Stress Echo  
Post-Cath Echo  
Post-Surgical Echo  
Imaging with Contrast Agents  
Sterilization Procedures  
Rating Stars (Click) SPECIAL VIEWS 1 2 3 4  
Pulmonary Veins  
Hepatic Veins  
Suprasternal Notch  
Rating Stars (Click) CALCULATIONS 1 2 3 4  
Simpson's Rule  
Proximal Isovelocity Surface Area  
Distology with TDI  
LV Strain/LV Volume  
Rating Stars (Click) PEDIATRIC ECHO 1 2 3 4  
Routine  
3-D Echo  
Pedoff Probe  
Transesophageal Echo  
Rating Stars (Click) PEDIATRIC ANOMALIES 1 2 3 4  
Aortic Arch Abnormalities/Vascular Ring  
Arch Sidedness  
Coarctation of the Aorta  
Coronary Artery Anomalies  
Double Outlet Ventricle  
Hypoplastic Heart Syndrome  
Pulmonary Venous Return Anomalies  
Tetralogy of Fallot  
Transposition of the Great Vessels  
Triscupid and Pulmonary Atresia  
Truncus Arteriosis  
Univentricular Heart Anomalies  
Rating Stars (Click) PEDIATRIC POST-SURGICAL SCANS 1 2 3 4  
Arterial Switch          
Blalock - Taussig          
Damus-Kaye-Stansel          
Fontan          
Glenn          
Konno          
Mustard          
Norwood          
Rastelli          
Sano          
Sennig          
Rating Stars (Click) EQUIPMENT 1 2 3 4  
Phillips/ATL (List Types)  
GE (List Types)  
Siemens (List Types)  
Toshiba (List Types)  
Hitachi (List Types)  
SonoSite (List Types)  
Other: List  
Rating Stars (Click) TECHNOLOGY 1 2 3 4  
McKesson  
Epic  
Horizon  
SCI- Imaging  
Online Reporting  
EMR Conversion  
Rating Stars (Click) MISCELLANEOUS 1 2 3 4  
12 Lead ECG  
Stress Testing  
Holter Monitor  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals  
Supervisory /Management Experience  
Isolation/Infection Prevention  
Procedures for Patients on Ventilators  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)  
CERTIFICATIONS      
Registered Diagnostic Cardiac Sonographer (RDCS)
 
Registered Cardiac Sonographer (RCS)
 
BLS