CYNET_SYSTEMS_MAIN_LOGO.gif   Informatics 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) CERNER 1 2 3 4  
Configuration   
Trainer - Implementation/Conversion   
Trainer - Ongoing Program   
Super User   
Implementation/Conversion  
Computerized Provider Order Entry (CPOE)   
Nursing Assessment   
Nursing Documentation  
Labs and Radiology   
MAR  
Bar Coded Medication Administration  
Rating Stars (Click) ECLIPSYS 1 2 3 4  
Configuration  
Trainer - Implementation/Conversion   
Trainer - Ongoing Program   
Super User  
Implementation/Conversion   
Implementation/Conversion   
Nursing Assessment   
Nursing Documentation   
Labs and Radiology  
MAR   
Bar Coded Medication Administration  
Rating Stars (Click) EPIC 1 2 3 4  
Configuration   
Trainer - Implementation/Conversion   
Trainer - Ongoing Program  
Super User   
Implementation/Conversion   
Computerized Provider Order Entry (CPOE)   
Nursing Assessment   
Nursing Documentation   
Labs and Radiology  
MAR   
Bar Coded Medication Administration  
Rating Stars (Click) GE/IDX 1 2 3 4  
Configuration  
Trainer - Implementation/Conversion   
Trainer - Ongoing Program  
Super User   
Implementation/Conversion   
Computerized Provider Order Entry (CPOE)   
Nursing Assessment  
Nursing Documentation  
Labs and Radiology   
MAR   
Bar Coded Medication Administration  
Rating Stars (Click) MCKESSON 1 2 3 4  
Configuration   
Trainer - Implementation/Conversion   
Trainer - Ongoing Program   
Super User   
Implementation/Conversion   
Computerized Provider Order Entry (CPOE)   
Nursing Assessment   
Nursing Documentation   
Labs and Radiology   
MAR   
Bar Coded Medication Administration  
Rating Stars (Click) MEDITECH 1 2 3 4  
Configuration  
Trainer - Implementation/Conversion   
Trainer - Ongoing Program   
Super User   
Implementation/Conversion   
Computerized Provider Order Entry (CPOE)   
Nursing Assessment   
Nursing Documentation   
Labs and Radiology  
MAR   
Bar Coded Medication Administration  
Rating Stars (Click) OTHER (PLEASE NAME BELOW) 1 2 3 4  
Other (specify here)   
Configuration   
Trainer - Implementation/Conversion   
Trainer - Ongoing Program   
Super User   
Implementation/Conversion   
Computerized Provider Order Entry (CPOE)   
Nursing Assessment   
Nursing Documentation   
Labs and Radiology   
MAR   
Bar Coded Medication Administration  
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 APPROPRIATE CARE 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)