CYNET_SYSTEMS_MAIN_LOGO.gif   Pathologist / Pathologist Assistant 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) SPECIMEN PROCESSING (IN THE ABSENCE OF GROSSING ASSISTANT) 1 2 3 4  
Specimen receipt verification and labeling  
Accessioning  
Rating Stars (Click) SURGICAL PATHOLOGY 1 2 3 4  
Performing frozen sections  
Using cryostat  
Rating Stars (Click) GROSS DESCRIPTION & DISSECTION OF SPECIMENS 1 2 3 4  
Large (Major resections)  
Medium (uterus/benign colon etc)  
Small (gall bladder, hernia, sac, etc)  
Biopsies  
Rating Stars (Click) COMMONALITIES OF SURGICAL AND AUTOPSY PATHOLOGY 1 2 3 4  
Obtaining and submitting tissues for additional analytic procedures  
Assisting in photographing gross and microscopic specimens  
Rating Stars (Click) AUTOPSY PATHOLOGY 1 2 3 4  
Overall postmortem technique  
Reviewing Medical records  
Developing preliminary autopsy diagnosis  
Gross Exam  
Initiating and assisting performance of post-mortem examinations  
Evisceration  
Removal of brain and spinal cord  
Exam Findings  
Rating Stars (Click) OTHER SKILLS 1 2 3 4  
LIS/HIS: Copath  
Cerner  
Other (rate)  
Rating Stars (Click) List Types 1 2 3 4  
Requisition review  
Voice recognition software  
Appropriate selection of material for photographs  
Billing Processes/CPT coding  
Application Agreement  
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)