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OPTHALMIC TECH
CHECKLIST
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NAME
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LAST 4 OF SSN
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DATE
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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.
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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.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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Front office duties
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1
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2
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3
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4
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Pulling charts
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Checking patients in and
patient flow
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Computer input and filing
records
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Scheduling appointments
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Care, maintenance, stocking
and set-up of assigned room(s)
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Rating Stars
(Click)
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Preliminary exams
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1
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2
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3
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4
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Visual acuity, pupil tests,
gross confrontational fields
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Retinoscopy and
refractometry, and applanation tonometry
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Snellen chart
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Jaeger chart
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Manual or automated
lensometry
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Measure prism in spectacles
and mark optical centers
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Labels medications
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Anesthetics and dilating
drops
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Preparing injections and
relaying prescriptions to pharmacy
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Familiar with medications
and ocular disease processes
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Rating Stars
(Click)
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Patient Care, Perform exams
& Assist MD
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1
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2
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3
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4
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Performs auto-refraction
prior to MD or OD exam
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Ishihara Color Vision
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Stereo, W4D
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Amsler
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Confrontational visual
fields (CVF)
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Extraocular movements
(EOMS)
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Titmus stereo testing
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Schirmer tear testing
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Cross cylinder technique
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Applanation or Tonopen
tonometry
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Clinical optics
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Strabismus screenings
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Dry eye, trauma, and
foreign particle work-up
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Neurological, cataract,
glaucoma work-up
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Neutralizes gas permeable
or hard contact lenses
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Angle assessment and pupil
assessment prior to dilating patient
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BAT and PAM tests as
directed by MD
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Corneal pachymetry
(appropriate according to specialty)
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Corneal topography
accurately
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Troubleshoot poor readings
or machine difficulties
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Blood Pressure and Pulse
Rates
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O2 administration under MDs
instructions
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Performs eye patching as
instructed by MD
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Non-imbedded foreign
particles with cotton swab
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Eye irrigation if
instructed by MD
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Performs pupil, muscle,
fluorescein dye testing for abrasions
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Applies dressings and
bandages
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Conjunctival and corneal
cultures
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Orders intraocular lens
(co-signed by physician)
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Rating Stars
(Click)
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Knowledge of
instruments/Diagnostic equipments
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1
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2
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3
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4
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Vannas scissors
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Jeweler's forceps
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Punctal dilators
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Lid specula
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A-Scans and Laser
Interferometry
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Visual Fields (Humphrey)
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Fluorescein Angiography and
Fundus Photography
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External Photography
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Minor calibration of
equipment
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Rating Stars
(Click)
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Documentation
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1
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2
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3
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4
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Patient past medical
history (systemic and ocular)
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Patient family medical
history (systemic and ocular)
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Taking patient's chief
complaint (reason for the visit)
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Knowledge of TJC standards,
HIPAA compliance
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Knowledge of medical
terminology
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Knowledge of medical office
practices
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Dictate accurate and timely
chart notes
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Electronic Chartings
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Rating Stars
(Click)
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Patient Education
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1
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2
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3
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4
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Insertion and removal
techniques of soft and hard contact lens
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Disinfecting, cleaning,
storing and care of contact lenses
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Explains discharge orders
and instructions to patient/family
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Rating Stars
(Click)
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EMR
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1
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2
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3
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST PARTUM
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CRITICAL UNIT
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LABOR & DELIVERY
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PACU
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NEWBORN NURSERY
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NEUROLOGY
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LEVEL II NICU
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TELEMETRY
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LEVEL III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING ROOM
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RRT
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EMERGENCY ROOM
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CRT
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TRAUMA CENTER
LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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AGE APPROPRIATE CARE
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1
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2
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3
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4
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Newborn/Neonatal (birth –
30 days)
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Infant (30 days-1 year)
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Toddler (1-3 years)
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Preschool (3-5 years)
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School Age Children (5-12
years)
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Adolescent (12-17 years)
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Young Adults (18-44 years)
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Middle Adults (45-64 years)
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Older Adults (>65 years)
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