GENERAL INFORMATION

Note: * Denotes a required field.

Please enter your full name as it appears on your Social Security Card: First Name   Middle Name   Last Name  * Please enter the Last Four digits of your Social Security Number:  -   -   *       Please check here if you do not hold a valid social security card. Please provide your contact information: Phone Number  * E-mail Address  * Confirm E-mail Address  * Type your e-mail address again above.

This profile is for use by healthcare professionals in the Physical Therapist discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

Orthopedic

1

2

3

4

Back syndromes

Hand injury

Arthritis programs

Hip fractures

Mobilization techniques

Neck injuries

Total hip/knee replacement

Total joint replacement/upper extremities

Transmandibular joint dysfunction

Neurologic

1

2

3

4

Neurosurgery

Spinal cord injury

Functional splinting

Head trauma

Stroke rehabilitation

Adaptive equipment

Sports Medicine

1

2

3

4

Bracing/joint immobilization

Biodex

Cybex

LIDO

Orthotron

Strength and endurance training

Taping/strapping

Nautilus/Eagle

Modalities/Manual Skills

1

2

3

4

Biofeedback

Acuscope

Continuous passive motion machine

Craniosacral therapy

Diathermy

Electro-acupunture

Extremity mobilization

Fluidotherapy

Hot/coldpacks

Hydrotherapy

Hubbard tank

Therapeutic pool

Whirlpool

Massage

Muscle energy techniques

Muscle stimulation

Myofascial release techniques

Neuro probe

Spinal mobilization

TENS

Therapeutic exercise/home programs

Traction

Cervical

Lumbar

Ultrasound

Vasopneumatic devices

Wound dressing

Strain/counter strain techniques

Paraffin

Prosthetics/Orthotics

1

2

3

4

Above knee prosthetics

Ankle foot orthosis

Below knee prosthetics

Dynamic splints

Gait analysis

Orthoplast/aquaplast

Serial/inhibitory casting

Static splints

Upper extremity prosthetics

Pediatrics

1

2

3

4

Cerebralpalsy

Early intervention

Equipment assessment

Activities of daily living

Adaptive

Gross motor assessment tools

Learning disabled

Mental retardation

Neurodevelopmental treatment

Orthotics

Spina bifida

Computerized Testing

1

2

3

4

Fatigue-characteristics

Fiber-type

Functional strength

Net muscular torque

ROM

Work-capacity

Other

1

2

3

4

Burn management

Cardiac rehabilitation

Chest physiotherapy

Computerized charting

Geriatrics

Inservice education

Wheelchair/equipment assessment

Work capacity evaluation

AGE SPECIFIC PRACTICE

1

2

3

4

Newborn/Neonate (birth - 30 days)

Infant (30 days - 1 year)

Toddler (1 - 3 years)

Preschooler (3 - 5 years)

School age children (5 - 12 years)

Adolescents (12 - 18 years)

Young adults (18 - 39 years)

Middle adults (39 - 64 years)

Older adults (64+)

Certification

BCLS

CPR

Computerized Charting System

Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox. * I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this Physical Therapist Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.

Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (3.236.51.151) which will be used as a digital signature.