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

Occupational 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  
    Energy conservation A B C D
    Joint protection A B C D
Hand injury A B C D
Hip fractures A B C D
Mobilization techniques A B C D
Therapeutic exercise A B C D
Total hip/knee replacement A B C D
Total joint replacement/upper extremities A B C D

NEUROLOGICAL
CVA A B C D
Head trauma A B C D
Peripheral nerve injuries A B C D
Spinal cord injury  
    Adaptive equipment A B C D
    Functional splinting A B C D
    Wheelchair evaluation A B C D
Stroke rehabilitation A B C D

PSYCHIATRIC
Acute disorders A B C D
Chronic disorders A B C D
Community re-entry A B C D
Crisis intervention A B C D
Group treatment A B C D
Standardized assessment tools A B C D
Substance abuse A B C D

PROSTHETICS/ORTHOTICS/FUNCTIONAL TRAINING
Above knee prosthetics A B C D
Below knee prosthetics A B C D
Dynamic splints A B C D
Myofascial release (MFR) A B C D
Orthoplast A B C D
Serial/inhibitory casting A B C D
Static splints A B C D
Upper extremity prosthetics A B C D

ADAPTIVE EQUIPMENT
Assessment A B C D
Fabrication A B C D
Functional activities  
    ADLs A B C D
    Home environment A B C D
    Pre-discharge planning A B C D
    Splinting A B C D
Wheelchair A B C D

VOCATIONAL TRAINING
Cognitive assessment A B C D
Functional capacity evaluation A B C D
Job task analysis A B C D
Perceptual assessment A B C D
Work hardening  
    BTE A B C D
    Valpar A B C D

PEDIATRICS
Developmental testing A B C D
Discharge planning (referral & resources) A B C D
Equipment assessment  
    Activities of daily living A B C D
    Wheelchair positioning device A B C D
Neurodevelopmental testing A B C D
Orthotics A B C D
Sensory integrative testing A B C D
Visual perceptual skills testing A B C D

MODALITIES
Biofeedback A B C D
Edema massage A B C D
Feeding techniques A B C D
Fluidotherapy A B C D
Muscle stimulation A B C D
Oral motor facilities A B C D
Paraffin bath A B C D
Therapeutic pool A B 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)
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.



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