Physical Therapy Skills

PPR Healthcare Staffing, Inc.
333 1st. St. North -- Suite 200
Jacksonville Beach, FL 32250
Fax:(888)794-5038

Physical Therapy Skills
Name:	Date:
Social Security number:	Email:
Instructions: Use the following Answer Key to indicate the extent of your previous experience:

Key - for each box mark:		A. Theory, no practice,	B. Intermittent experience,
		C. One - two years experience,	D. Two plus years experience

ORTHOPEDIC
Arthritis programs	AB C D
Back syndromes	AB C D
Hand injury	AB C D
Hip fractures	AB C D
Mobilization techniques	AB C D
Neck injuries	AB C D
Total hip/knee replacement	AB C D
Total joint replacement/upper extremities	AB C D
Transmandibular joint dysfunction	AB C D

SPORTS MEDICINE
Biodex	AB C D
Bracing/joint immobilization	AB C D
Cybex	AB C D
LIDO	AB C D
Nautilus/Eagle	AB C D
Orthotron	AB C D
Strength and endurance training	AB C D
Taping/strapping	AB C D

MODALITIES/MANUAL SKILLS
Acuscope	AB C D
Biofeedback	AB C D
Continuous passive motion machine	AB C D
Craniosacral therapy	AB C D
Cryotherapy	AB C D
Diathermy	AB C D
Electro-acupuncture	AB C D
Extremity mobilization	AB C D
Fluidotherapy	AB C D
Hot/cold packs	AB C D
Hydrotherapy
Hubbard tank	AB C D
Therapeutic pool	AB C D
Whirlpool	AB C D
Massage	AB C D
Muscle energy techniques	AB C D
Muscle stimulation	AB C D
Myofascial release techniques	AB C D
Neuro probe	AB C D
Paraffin	AB C D
Spinal mobilization	AB C D
Strain/counter strain techniques	AB C D
TENS	AB C D
Therapeutic exercise/home programs	AB C D
Traction
Cervical	AB C D
Lumbar	AB C D
Ultrasound	AB C D
Vasopneumatic devices	AB C D
Wound dressing	AB C D

PROSTHETICS/ORTHOTICS
Above knee prosthetics	AB C D
Ankle foot orthosis	AB C D
Below knee prosthetics	AB C D
Dynamic splints	AB C D
Gait analysis	AB C D
Orthoplast/aquaplast	AB C D
Resting splints	AB C D
Serial/inhibitory casting	AB C D
Static splints	AB C D
Upper extremity prosthetics	AB C D

PEDIATRICS
Cerebral palsy	AB C D
Early intervention	AB C D
Equipment assessment
Activities of daily living	AB C D
Adaptive	AB C D
Gross motor assessment tools	AB C D
Learning disabled	AB C D
Mental retardation	AB C D
Neurodevelopmental treatment	AB C D
Orthotics	AB C D
Spina bifida	AB C D

OTHER
Burn management	AB C D
Cardiac rehabilitation	AB C D
Chest physiotherapy	AB C D
Functional capacity evaluation	AB C D
Geriatrics	AB C D
Inservice education	AB C D
Wheelchair/equipment assessment	AB C D
Work capacity evaluation	AB C D

EXPERIENCE WITH AGE GROUPS:

AGE SPECIFIC PRACTICE CRITERIA
Please check the boxes below for each age group for which you have expertise in providing age-appropriate care.
A. Newborn/Neonate (birth - 30 days)	F. Adolescents (12 - 18 years)
B. Infant (30 days - 1 year)	G. Young adults (18 - 39 years)
C. Toddler (1 - 3 years)	H. Middle adults (39 - 64 years)
D. Preschooler (3 - 5 years)	I. Older adults (64+)
E. School age children (5 - 12 years)

	A	B	C	D	E	F	G	H	I
Able to adapt care to incorporate normal growth and development.

Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.

Can ensure a safe environment reflecting specific needs of various age groups.

Certification:
Please check the boxes below and indicate the expiration date for each certificate that you have. If you do not know the exact date, please use the last date of the specific month (e.g., 01/02/2004).
BCLS	Exp. date: (mm/dd/yyyy)
CPR	Exp. date: (mm/dd/yyyy)
Other:	Exp. date: (mm/dd/yyyy)
Computerized charting system:	Exp. date: (mm/dd/yyyy)

The information I have given is true and accurate to the best of my knowledge. I hereby authorize PPR to release this information to Client facilities of PPR in relation to consideration of my employment with those facilities.


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