Self Assessment
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Do you have any experience with this skill?
Are you competent performing the following?
Competency for the Physical Therapist
Proficiency Required
Evaluation Method
Competency Validation Indicated by Preceptors Initials and Date
Yes
No
Yes
No
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A. Demonstrates ability to process paperwork and associated functions necessary to facilitate :
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1. Knowledge of Assessment Process :

a. Health history and psychosocial history

b. Development of problem list

c. Assists in the development of care plan

d. Assesses response to treatment

e. Establishes and revises goals

f. DC planning

g. Conducts complete initial evaluation

h. Other :

2. Documentation Skills: (accurate, timely, complete and legible) :

a. 485, 486, 487

b. Progress notes, flow charts

c. Summary reports

d. Incident/variance reporting

e. Other :

3. Adheres to POC :

a. Reviews POC prior to care

b. Performs services as ordered

c. Documents according to POC

d. Communicates/coordinates as appropriate

e. Other :

4. Knowledge of Medicare/State Guidelines :

a. Criteria for participation

b. Skilled reimbursable visit

c. Other :

5. Reports and documents key information to Physician, DC Planner, Clinician, Pharmacist, Supervisor

6. Participates as team member

7. Submits written summary reports as indicated

8. Attends/participates in case conferences as required

9. Supervision of Ancillary Personnel :

a. HHA

10. Supply/HME requisition and management

11. Infection Control Practices :

a. Hand washing

b. Personal protective equipment

c. Exposure control plan

d. Equipment care, as appropriate

e. Other :

12. Patient home safety

13. Other :

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B. Patient Education
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1. Determines learning needs

2. Sets objectives

3. Develops/implements teaching plan

4. Evaluates effectiveness of teaching

5. Revises teaching plan

6. Documents patient response

7. Other :

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C. Clinical Skills – General
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1. Vital Signs

2. Other :

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D. Assessment and Evaluation
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1. Mental Status/Cognition (judgment, memory judgment, orientation, sequencing, following directions, problem solving)

2. Musculoskeletal-Skeletal (ROM, posture, deformity)

3. Pain (location, intensity, relief)

4. Neuro-Muscular Function (motor control, strength, coordination, tone, reflexes)

5. Sensation

6. Endurance

7. Functional Findings

a. Bed mobility

b. Gait

c. Transfers

d. Equipment management

8. Environmental eval/Architectural barriers

9. Other tests or measurements

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E. Skilled Treatments/Interventions
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1. Perform therapeutic exercises :

a. Active

b. Passive

c. Strengthening and endurance

d. Other

2. Transfer Activities

3. Mobilization :

a. Bed mobility

b. Gait training

c. Other :

4. Use of Physical Agents :

a. Ultrasound

b. Hot/cold packs

c. TENS\FES

d. Massage

e. Other :

5. Prosthetic Training

a. Care of prosthesis

b. Stump conditioning

c. Other :

6. Assistive Devices

a. Fit/adjustment

b. Gait training

c. Safety

d. Other :

7. Fabricates orthotic device, instructs in use

8. Management and evaluation of the patients care plan

9. Other :