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

  

Radiology Skills Checklist
First Name:
Last Name:
Phone:
Email:
SSN (last 4 only):
Date:
 
Key - for each box mark:   A. Theory, no practice B. Intermittent experience
    C. One - two years experience D. Two plus years experience

GENERAL DIAGNOSTIC
Abdomen AB C D
Abdominal arteriogram AB C D
Air-contrast barium enema AB C D
Angioplasty AB C D
Arch arteriogram AB C D
Barium enema AB C D
Barium swallow/small bowel series AB C D
Bone density AB C D
Brachial arteriogram AB C D
Bronchogram AB C D
C-arm fluoroscope AB C D
Carotid arteriogram AB C D
Cervical spine AB C D
Chest series AB C D
ER exams AB C D
ERCP AB C D
Esophogram AB C D
Extremities AB C D
Facial series AB C D
Femoral arteriogram AB C D
Foreign body localization AB C D
Gall bladder AB C D
GI series AB C D
Hip series AB C D
Hypotonic duodenography AB C D
Hysterosalpingogram AB C D
IVP AB C D
KUB AB C D
Lumbar spine AB C D
Lung biopsy AB C D
Mammogram AB C D
Mastoids AB C D
Mesenteric arteriogram AB C D
Myelogram AB C D
Needle localization AB C D
OR exams AB C D
Pediatric exams AB C D
Peripheral dexascan AB C D
Portables AB C D
Pulmonary arteriogram AB C D
Renal arteriogram AB C D
Renal cyst puncture AB C D
Salpingogram AB C D
Selective angiography AB C D
Sialography AB C D
Skull series AB C D
Small bowel series AB C D
Soft tissue AB C D
Specimen radiographs AB C D
Surgery experience - C-arm AB C D
Therapy placement films AB C D
Thoracic spine AB C D
Tomogram AB C D
Transhepatic cholangiogram AB C D
Trauma AB C D
T-Tube cholangiogram AB C D
Voiding cystourethrogram AB C D

CT SCANNING
Abdomen AB C D
Biopsy procedures AB C D
Brain with contrast AB C D
Brain without contrast AB C D
Cervical spine AB C D
Chest AB C D
Gradient echo imaging AB C D
IAC AB C D
Larynx AB C D
Liver AB C D
Lumbar spine AB C D
MR angiography AB C D
Multiplanar reconstruction AB C D
Orbits AB C D
Pancreas AB C D
Partial saturation image AB C D
Pelvis AB C D
Renal cyst puncture AB C D
Spin-echo images AB C D
Surface coils AB C D
Thoracic spine AB C D
TM joints AB C D

NUCLEAR MEDICINE
Bone scan AB C D
Brain scan AB C D
Cerebral blood flow AB C D
Gallium scan AB C D
GI bleeding study AB C D
I-123 uptake AB C D
I-131 therapy AB C D
Liver scan AB C D
Lung scan AB C D
MUGA scan AB C D
Radionuclide arteriogram AB C D
Radionuclide venogram AB C D
Renal scan AB C D
SPECT scanning AB C D
Spleen scan AB C D
Thallium stress test AB C D
Thyroid scan AB C D
Thyroid therapy AB C D

ULTRASOUND
Aorta AB C D
Biliary tree AB C D
Biopsy puncture AB C D
Breast AB C D
Carotid AB C D
Cyst aspiration AB C D
Doppler studies AB C D
Gall bladder AB C D
Heart AB C D
Liver AB C D
Neonatal head AB C D
OB/GYN AB C D
OPG eye AB C D
Pancreas AB C D
Pelvic AB C D
Popliteal AB C D
Renal AB C D
Thyroid AB C D
Transrectal procedures AB C D
Transvaginal procedures AB C D
UGI and small bowel AB C D
Venogram AB C D

RADIATION THERAPY
Cobalt 60 therapy AB C D
Dosimetry AB C D
Hyperthermia treatment AB C D
Linear accelerator with electrons AB C D
Linear accelerator AB C D
Ortho voltage radiation treatment AB C D
Simulation of treatment sites AB C D
Strontium 90 therapy AB C D
Superficial radiation treatment AB C D
Treatment planning AB C D

MRI TECHNOLOGIST
Gradient echo imaging AB C D
Multiplanar reconstruction AB C D
Partial saturation images AB C D
Spin-echo images AB C D
Surface coils AB C D
T-1 weighted images AB C D
T-2 weighted images AB C D

EQUIPMENT
GE .5 AB C D
GE 1.0 AB C D
GE 1.5 AB C D
Hitachi .5 AB C D
Hitachi 1.0 AB C D
Hitachi 1.5 AB C D
Phillips .5 AB C D
Phillips 1.0 AB C D
Phillips 1.5 AB C D
Picker .5 AB C D
Picker 1.0 AB C D
Picker 1.5 AB C D
Siemens .5 AB C D
Siemens 1.0 AB C D
Siemens 1.5 AB C D
Toshiba .5 AB C D
Toshiba 1.0 AB C D
Toshiba 1.5 AB C D
Other, AB C D
Other, AB C D
Other, AB C D
Other, AB C D

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)

EXPERIENCE WITH AGE GROUPS:
    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.  

My experience is primarily in: (Please indicate number of years.)
Practice area: , year(s)
Radiology: , year(s)
 
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)
ACLS 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.



Submitting this form may take a few moments, please be patient. Thank you.
© 2004-2008 PPR