CYNET_SYSTEMS_MAIN_LOGO.gif   MAMMOGRAPHER 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) Interventional 1 2 3 4  
Core biopsy  
Ductography  
Fine needle aspiration  
Breast specimen imaging  
Pneumocystography  
Other (list):  
Rating Stars (Click) General 1 2 3 4  
Density setting  
Cm of compression  
Film processing  
Photocell positioning  
mAs application  
kVp (high vs. low) application  
MQSA (Mammography Quality Standards Act) Standards  
Compton effect  
Xeromammography  
Screening mammogram  
Photoelectric effect  
Post partum mastitis  
Post menopausal  
Pre menopausal  
Diagnostic mammogram  
Rating Stars (Click) Positions/Views 1 2 3 4  
Mediolateral projection  
Craniocaudal  
Modified Oblique  
Lateromedial  
Lateromedial oblique  
Spot compression  
Implant displaced  
Other (list):  
Rating Stars (Click) Specialties 1 2 3 4  
Males  
Irradiated breast  
Chest wall deformities  
Post - surgical breast  
Kyphotic patients  
Reduction mammoplasty  
Protruding abdomen  
 Implants  
Pacemaker  
Port-a-cath  
Mastectomy-partial and radical  
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)