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Payroll Application Medical Inservice Skills Checklists     MRI Name: Verify ID: Date: Click To Highlight: 1 - No Experience 2 - Minimal 3 - Moderate 4 - Very Experienced A. MRI 1   2   3   4     T1 Weighted Imaging           T2 Weighted Imaging           Gradient Echo Imaging           Surface Coils           Spin Echo Imaging           Angio Studies           Multiplanar Rreconstruction           Contract Studies           Partial Saturation Imaging           Brain           MRA Brain           Orbits           Corotid MRA           IAC´s           TMJ           C-Spine           L-Spine           T-Spine           Hand ⁄ Wrist           Elbow           Shoulder           Chest           Breast           Brachail Plexus           Liver           Kidney           Adrenal           Foot           Ankle           Lower Leg           Knee           Femur           Pelvis           Hip         B. Equipment     GE Horizon LX           GE Signa           GE Tesla           Hitachi Airus (open)           Toshiba Opart (open)           Siemens           Other       C. Certification ⁄ Registries Date   ARRT Expiration Date   MRI Expiration Date   BCLS Expiration Date   ACLS Expiration Date   Eligible   Other D. Age Specific Criteria 1   2   3   4     Newborn/Neonatal (up to 30 days)           Infant (30 days to 1 year)           Toddler (1 to 3 years)           Preschooler (3 to 5 years)           School Age (5 to 12 years)           Adolescents (12 to 18 years)           Young Adults (18 to 39 years)           Middle Adults (40 to 64 years)           Older Adults (65 & up)         E. Facility Setting Years Experience   Small Hospital   Large Hospital   Outpatient   Clinic

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