PHARMACIST_SKILLS

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