Cath Lab Technologist

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Director of Rehab

OT

COTA

PT

PTA

SLP/SLPA

CNA

Director of Nursing

LPN

MDS Coordinator

Medication Aide

LTC RN

Ambulatory RN

Antepartum Postpartum Nursery

Behavioral Health RN

Case Management

Cath Lab RN

Certified Surgical First Assistant

CVICU RN

CVOR RN

CVOR Surgical Tech

Dialysis RN

Endoscopy RN

Endoscopy Tech

ER RN

High Risk Skills

Home Health RN

Infection Prevention RN

Intensive Care RN

Infusion RN

LDRP RN

LTAC RN

Maternal Fetal/High Risk

Medical Surgical / Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

OR/Surg Tech

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric RN

Sterile Processing Technologist

Surgical Tech

Tele, PCU, Stepdown RN

Transplant Coordinator RN

Home Health Case Manager

Home Health Clinical Manager

Home Infusion RN

Home Health LPN

Home Health RN

Hospice LPN

Hospice RN

Cath

CT Tech

Dosimetrist

Echo

High Risk Skills

Histotechnologist

Interventional Skills

Mammography Skills

MRI Technologist

Nuclear Medicine Technologist

OR/Surg Tech

Pharmacist

Pharmacy Technician

Radiologic Technologist

Radiation Therapist

Sterile Processing Tech

Ultrasound Tech

Vascular Ultrasound

Cytotechnologist

Histotechnologist

Medical Laboratory Technologist

Medical Technologist

Pathologist Assistant

Phlebotomy

Cath Lab RN

Cath Lab Technologist

Cath EP

Interventional Skills

Anesthesia Tech

Dietician

EKG Tech

Perfusionist

Polysomnographer / RPSGT

Respiratory Therapist

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Marvel Medical Staffing.
- 0 = Not Applicable
- 1 = No Experience
- 2 = Some Experience
- 3 = Intermittent Experience
- 4 = Experienced
- 5 = Very Experienced
*Required Field
Circulating Role (PAV)

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Air Way Maintenance*
Arm Cases*
Biopsy*
Co-Ox Setup QC, Run Sample*
DCAs*
Defibrillator Setup / Use*
IABP*
Left Heart*
RA Pressure Waveform Recognition*
RV Pressure Waveform Recognition*
PA Pressure Waveform Recognition*
PCW Pressure Waveform Recognition*
LVEDP*
Ejection Fraction*
Power Injector Setup / Use*
PTCAs*
Psycho / Social*
Patient / Family Teaching*
Patient / Fam Teach Pre / Post Proced*
Left Heart Catheterization*
Right Heart Catheterization*
Left & Right Heart Catheterization*
Stent Implantation*
Ventricular Pacers*
Push Drugs ordered by MD*
Radiation Protection*
Directional Coronary Atherectomy*
Permanent Pacemaker*
Temporary Pacemaker*
Setting Threshold of Pacemakers*
Rotoblator*
Sphygmomanometer Monitoring*
Stents*
Transducer Setup / Calibration*
Run Co-Ox Machine*
Run Angio Jet Machine*
IVUS*

Recording Position

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Biopsy*
Call in Reports*
DCAs*
PTCAs*
Left Heart Caths*
Right Heart Caths*
Stents*
Hematoma Recognition & Mgt*
Rotational Coronary Atherectomy*
IVUS*
Intra-Aortic Balloon Pump*
Directional Coronary Atherectomy*
EP Study*
Ablation*
Cardioversion*
Rotoblator*

Scrub Position (PCS)

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Left Heart Catheterization*
Right Heart Catheterization*
Left & Right Heart Catheterization*
Stent Implantation*
Rotational Coronary Atherectomy*
IVUS*
Intra-Aortic Balloon Pump*
Biopsy*
Closure Device (Pre close, Angio Seal)*
DCAs*
Temporary Pacemakers*
Angio Jet*
Arm Cases*
Exchange Sheaths*
Directional Coronary Atherectomy*

Cath Lab / Angio / Specials

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

GE Advantx LC Mobile*
GE LUA Mobile*
GE LUA/C MobileGE LUA/EDEC*
Philips Integris H3000*
Philips Integris Mobile*
Philips Integris V3000*
Philips MD-3*
Philips Poly A Combo Mobile*
Philips Poly A Mobile*
Philips Poly C Mobile*
Philips Poly C2*
Philips Poly C-2 Mobile*
Philips Poly C-2 Modular*
Siemens ACOM M/B*
Siemens Angioskop D*
Siemens Angioskop D-2*
Siemens Angiostar*
Siemens Axiom Artis BC*
Siemens Axiom Artis FC*
Siemens Cathcor*
Siemens Coroskop C*
Siemens Hicor 1.0/2.0*
Siemens Infinity SC 7000*
Siemens Infinity SC 8000*
Siemens Infinity SC 9000XL*
Siemens PolyStar*
Siemens Powermobile *
Toshiba Angiorex Modular*
Toshiba Infinix VC-i*
Toshiba KXO-200A*
Toshiba KXO - 80 - CD Mobile*
Toshiba Super G*

Radiology / Fluoroscopy

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

GE Prestige*
GE Prestilix 1690*
GE RFX*
GE SFX-ll*
Litho Gall Bladder*
Litho Kidney*
Philips Diagnost 92*
Picker Clinix R/F*
Picker Vector 100*
Siemens Pantoskop 5 ML*
Siemens Sireskop 30*
Siemens Sireskop 4*
Siemens Sireskop SX*
Toshiba EPS-Plus*
Toshiba KXO-850*
Toshiba Tosrad*
Toshiba Ultimax*
Atak R/F Ablation IABP*
Daylight System*
Digatech*
GE Advantx*
GE Advantx 80 LFX*

Hemodynamic Monitoring Equipment

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Hewlett Packard*
Lifecare*
Marquette*
Mennen*
Nihon Koder*
Philips*
Siemens*
Spacelab*
Witt*

Age Specific Practice Criteria

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

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+ years)*

EMR

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

AllScripts*
ARIA*
Athena*
Canopy*
Epic*
Cerner*
Eclipsys*
McKesson*
Meditech*
Other Computerized System*
Computerized Physician Order Entry*
Bar Coding for Medication Administration*
Application Agreement*
- I certify that the test was filled out to the best of my knowledge.
Signature*
Date*
First Name*
Last Name*
Applicant Email*
Applicant Phone*

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