PT Skills Checklist

Please complete this checklist as accurately as possible as it helps your MAS Medical recruiter understand your areas of expertise.

The purpose of this checklist is to more clearly outline the Physical Therapist's areas of expertise. Please complete this checklist as accurately as possible.
Today's Date
First Name*
Last Name*
Email*
Certifications and Expiration Date
If none, please put n/a.
BCLS*
ACLS*
CPR*
Other*
Other*
State PT Licenses and Expiration*
Please indicate your level of experience.

A. ORTHOPEDICS
Arthritis Program*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Rehabilitation of patient with:
a. Ankle Reconstruction*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
b. Ankle Sprain*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
c. Cervical Spine*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
d. Hand Injuries*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
e. Hip Fractures*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
f. Neck Injuries*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
g. TMJ Dysfunction*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
h. Total Hip/ Total Knee Replacemen*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
i. Total Joint Replacement/Upper Extremities*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Therapeutic Exercise*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
a. Energy Conservation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
b. Joint Protection*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Mobilization Techniques*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
B. SPORTS MEDICINE
Biodex*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Bracing/ Joint Mobilization*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Cybex*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
LIDO*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Nautilus/ Eagle*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Orthotron*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Strength and Endurance Training*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Taping/ Strapping*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
C. NEUROLOGIC
Head Trauma*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Spinal Cord Injuries*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
CVA Rehabilitation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Stroke Rehabilitation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
a. Functional Splinting*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
b. Adaptive Equipment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Peripheral Nerve Injuries*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Cognitive Retraining*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Traumatic Brain Injury*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
D. MODALITIES
Biofeedback*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Continuous Passive Motion Machine (CPM)*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Cryotherapy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Diathermy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Electro-acupuncture*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Fluidotherapy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Hot/ Cold Packs*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Hydrotherapy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
a. Hubbard Tank*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
b. Therapeutic Pool*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
c. Whirlpool*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Paraffin Bath*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
TENS*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Edema Massage*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Burn Management*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Oral Motor Facilitation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Traction/ Lumbar*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Ultrasound*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Vasopneumatic Devices*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
E. MANUAL SKILLS
Craniosacral Therapy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Extremity Mobilization*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Massage*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Muscle Stimulation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Myofascial Release Techniques*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Spinal Mobilization*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Strain Counter/ Strain Techniques*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
F. PROSTHETICS/ORTHOTICS
Above Knee Prosthetics*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Below Knee Prosthetics*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Upper Extremity Prosthetics*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Gait Analysis*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Orthoplast/ Aquaplast*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Serial/Inhibitory Casting*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Dynamic Splints*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Static Splints*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Functional Splinting*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
G. PEDIATRICS
Cerebral Palsy*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Autism*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Down's Syndrome*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Neurodevelopment Testing/ Treatment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Sensory Integrated Testing/ Treatment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Developmental Testing/ Treatment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Visual Perceptual Testing/ Treatment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
NICU Treatment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Discharge Planning*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Equipment Assessment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
a. Activities of Daily Living (ADL's)*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
b. Wheelchair Positioning Device*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Learning Disabilities*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Early Intervention*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Orthotics*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
H. COMPUTERIZED TESTING
Fatigue - Characteristics*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Fiber - Type*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Functional Strength*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
New Muscular Torque*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
ROM*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Work - Capacity*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
I. OTHER
Burn Management*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Cardiac Rehabilitation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Chest Rehabilitation*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
In-service Education*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
Wheelchair/Equipment Assessment*
Theory, No Practice Intermittent Experience 1-2 Years of Experience More Than 2 Years of Experience
EXPERIENCE WITH AGE GROUPS
Able to adapt care to incorporate normal growth and development.*
- Neo-Natal
- Peds
- Adolescent
- Adult
- Geriatrics
Able to adapt method and terminology of patient instruction to age, comprehension and maturity level.*
- Neo-Natal
- Peds
- Adolescent
- Adult
- Geriatrics
Able to ensure a safe environment reflecting specific needs of age group.*
- Neo-Natal
- Peds
- Adolescent
- Adult
- Geriatrics
TOTAL YEARS OF EXPERIENCE WITH SETTINGS
General Acute Care*
Rehabilitation Hospital*
Home Health*
Long Term Care*
Nursing Home*
Out Patient Clinic*
Pediatric Rehabilitation*
Industrial Setting*
School System*
Confirmation*
- I attest that the information I have provided is true and accurate to the best of my knowledge
I am the individual completing this form. By checking this box I authorize MAS Medical Staffing to release this checklist to client facilities in consideration for employment.

Certifications and Expiration Date

A. ORTHOPEDICS

B. SPORTS MEDICINE

C. NEUROLOGIC

D. MODALITIES

E. MANUAL SKILLS

F. PROSTHETICS/ORTHOTICS

G. PEDIATRICS

H. COMPUTERIZED TESTING

I. OTHER

EXPERIENCE WITH AGE GROUPS

TOTAL YEARS OF EXPERIENCE WITH SETTINGS