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Payroll Application Medical Inservice Skills Checklists     Speech Language Pathology Name: Signature: Date: Click To Highlight: 1 - No Experience 2 - Minimal 3 - Moderate 4 - Very Experienced A. Speech Therapy 1   2   3   4   1.Adult   CVA           Coma Stimulation           Degenerative Diseases           Mental Retardation - Mild           Mental Retardation - Moderate           Mental Retardation - Severe           Mental Retardation - Profound           Anoxia           Laryngectormy           Tracheotomy           Ventilator Dependent / Assisted           Fluency           Voice           Screenings           Hearing Impairments           Sign Language         2. Adaptive Equipment   Communication Board           Augmentative/Alternative           Communication Devices           Memory Aide           Feeding Equipment         3. Dysphagia   Besides Swallow Evaluation           Modified Barium Swallow Study           Thermal Stimulation           Thickening Agents           Compensatory Techniques           Laryngectormy           Tracheotomy           Ventilator Dependent / Assisted         4. Pediatric   Traumatic Brain Injury (TBI)           Cerebral Palsy           Early Intervention           Learning Disabilities           Mental Retardation - Milid           Mental Retardation - Moderate           Mental Retardation - Severe           Mental Retardation - Profound           Articulation           Language           Fluency           Voice           Tracheotomy           Group Treatment           A. Speech Therapy 1   2   3   4   5. Other   Medicare Documentation           Home Health Documentation           Family Education           Inservice Education           Transfer Training           Videostroboscopic Voice Evaluation           Aural Rehabilitation           Functional Maintenance           Video Fluroscopy           Multiple Sclerosis           Muscular Dystrophy         6. Age   Newborn (Birth - 30 days)           Infant (30 days - 1 year)           Toddler (1 - 3 years)           Preschooler (3 - 5 years)           School Age (5 - 12 years)           Adolescents (12 - 18 years)           Young Adults (18 - 39 years)           Middle Adults (39 - 64 years)           Older Adults (64+ years)

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