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CYNET_SYSTEMS_MAIN_LOGO.gif   Pharmacist 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) Practice Settings/Experience  1 2 3 4  
0
 Academia   
0
 Ambulatory Care   
0
 Clinic  
0
 Compounding   
0
 Consulting   
0
 Correctional Facility (Jail)  
0
 Diabetes  
0
 Drug Information  
0
 Formulary Management   
0
 Geriatrics   
0
 Home Health  
0
 Home Infusion   
0
 Hospital– Inpatient  
0
 Hospital– Outpatient  
0
 Infectious Disease  
0
 Long Term Care (LTC)  
0
 Mail Order  
0
 Military/Government/VA   
0
 Nuclear   
0
 Oncology   
0
 Pain Management   
0
 Pediatrics   
0
 Pharmaceutical Research  
0
 Pharmaceutical Sales  
0
 Pharmacy Benefits Management (PBM )  
0
 Poison Control   
0
 Psychiatric Patient Management   
0
 Public Health  
0
 Renal Patient Management   
0
 Retail– Chain   
0
 Retail– Independent  
0
 Sub-Acute Care  
0
 Veterinary  
0
 Other:   
0
 Other:  
0
 Other:   
Rating Stars (Click) Pharmacy Software Systems  1 2 3 4  
0
 Etreby  
0
 HBS   
0
 JASRx  
0
 McKesson– 3PM  
0
 McKesson– Pharmserv  
0
 Meditech   
0
 NDC  
0
 OPUS– ISM  
0
 OSCOR  
0
 PDX  
0
 PharmNet  
0
 Pharmtrak  
0
 PROScript 2000  
0
 QS1  
0
 Renlar  
0
 Rescot– Omni-DX  
0
 Rx-Link   
0
 Speed Script  
0
 TechRx   
0
 WinPharm  
0
 Other:  
Rating Stars (Click) Automation 1 2 3 4  
0
 Accumed/Baker Cells   
0
 BAXA– Rapid-Fill (ASF)  
0
 BAXA– Repeater Pump   
0
 Baxter  
0
 Baxter– AUTOMIX Compounder  
0
 Baxter– MICROMIX Compounder  
0
 Kirby Lester   
0
 McKesson– AcuDose-Rx  
0
 McKesson– Baker Scale  
0
 McKesson– IntelliShelf-Rx   
0
 McKesson– MedCarousel   
0
 McKesson– ROBOT– Rx   
0
 McKesson– PACMED  
0
 MTS– Automated Sealers  
0
 MTS– Prepackaging  
0
 Parata– PACMED  
0
 Parata– RDS  
0
 Parata– APM  
0
 PharmASSIST– RDS ROBOTx  
0
 PharmASSIST– ROBOTx  
0
 PharmASSIST– SmartCabinet  
0
 PharmASSIST– SmartScale  
0
 Pyxis  
0
 Other:   
0
 Other:   
Rating Stars (Click) Disease State Management 1 2 3 4  
0
 AIDS/HIV  
0
 Anticoagulation   
0
 Asthma  
0
 Cardiovascular Disease  
0
 Chemotherapy   
0
 Cystic Fibrosis  
0
 Depression  
0
 Diabetes   
0
 Dyslipidemia   
0
 Hormone Replacement Therapy  
0
 Hypertension  
0
 Osteoporosis   
0
 Pain Management  
0
 Smoking Cessation  
0
 Transplant  
0
 Other:   
0
 Other:  
0
 Other:   
Rating Stars (Click) Clinical and Job related Experience  1 2 3 4  
0
 Admixture   
0
 Adolescent Care   
0
 Aseptic Techniques  
0
 Blister Packs   
0
 Cart Check   
0
 Cart Fill  
0
 Chemotherapy  
0
 Computerized Physician Order Entry   
0
 Consulting   
0
 Discharge Counseling  
0
 DME Equipment  
0
 Drug Information  
0
 Drug Information Rounds  
0
 Drug Rehabilitation Programs   
0
 Emergency Room  
0
 Enteral Nutrition Products  
0
 Formulary Management   
0
 Geriatric Care   
0
 Hazardous Drug Handling   
0
 Homeopathic Treatments  
0
 Hyperalimentation Calculation   
0
 Immunizations  
0
 Immunoglobulin Therapy  
0
 Incontinence Supplies  
0
 Infectious Disease  
0
 Infusion Pumps and Systems  
0
 Intensive Care (ICU)   
0
 IV Preparation  
0
 Neonatal Intensive Care (NICU)  
0
 Oncology   
0
 Ostomy Supplies  
0
 OTC selection and recommendations   
0
 P&T committee participant   
0
 Pain Management   
0
 PCA Pumps  
0
 Pediatric Care   
0
 Poison Control   
0
 Psychiatric Care  
0
 Retail Compounding  
0
 Surgical Supplies  
0
 Tocolytic Therapy  
0
 TPN Preparation  
0
 Transplant Therapy  
0
 Urological Supplies  
0
 Other:   
0
 Other:   
0
 Other:   
Rating Stars (Click) EMR 1 2 3 4  
0
 Epic  
0
 Cerner  
0
 Eclipsys  
0
 McKesson  
0
 Meditech  
0
 Other Computerized System  
0
 Computerized Physician Order Entry  
0
 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  
0
 Newborn/Neonatal (birth – 30 days)  
0
 Infant (30 days-1 year)  
0
 Toddler (1-3 years)  
0
 Preschool (3-5 years)  
0
 School Age Children (5-12 years)  
0
 Adolescent (12-17 years)  
0
 Young Adults (18-44 years)  
0
 Middle Adults (45-64 years)  
0
 Older Adults (>65 years)  
Rating Stars (Click) Pharmacokinetic Dosing of 1 2 3 4  
0
 Aminoglycosides  
0
 Anticoagulation  
0
 Digoxin   
0
 Lithium  
0
 Theophylline  
0
 Vancomycin  
0
 Other:   
0
 Other:   
0
 Other: