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Payroll Application Medical Inservice Skills Checklists     Physical Therapist/Physical Therapist Assistant Name: Signature: Date: Click To Highlight: 1 - No Experience 2 - Minimal 3 - Moderate 4 - Very Experienced 1. Physical Therapy 1   2   3   4   A. Acute   Gait Training           General Medical           General surgical           Orthopedics           Wound Care           Cardiac           ICU/SICU           Oncology           Geriatrics           Respiratory           Transplant         a Neurological           - CVA           - SCI           - MS           - Parkinson's           - TBI         B. Work Hardening   FCE           Work site evaluation           Work hardening           Chronic Pain           NDT           Aquatics           Home care           - Oasis Paperwork         C. Extended Care   Free standing           Hospital based           MDS           RUGS Levels         D. Pediatrics   Acute           Rehabilitation           School based           Positioning aids           Wheelchair fitting           Neonatal           Outpatient           Oral motor           Assisted tech/classroom adaptation         E. Outpatient   Manual Therapy                   - Spinal           - Extremity           E. Outpatient Cont. 1   2   3   4   Backs   - McKenzie           - Maitland           - Other:         Necks   - McKenzie           - Maitland           - Other:         Knees   - ACL Rehab           - Arthroscopic surgery           - Patello-Femoral Disorders           Soft tissue trauma           Wound care           Arthritis           Progressive strengthening           Orthotics prescription           Prosthetics fitting & training           Sports Medicine         Modalities   - US/Phono           - Traction           - Heat/Cold           - Myofascial release           - Electrical stimulation           - Whirlpool           - Inotophoresis           - EMG/NCV           - Biofeedback           - TENS         Isokinetics   - BTE           - Cyubex Biodex           - KinCom           - Lido         F. Documentation   700 & 701 Forms           MDS Forms

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