Pharmacy Tech Skills Checklist

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Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

Confirm email: *

WORK SETTING EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Ambulatory Care	123
Clinic	123
Compounding	123
Consulting	123
Correctional Facility	123
Geriatrics	123
Home Health	123
Home Infusion	123
Hospital-in patient	123
Hospital-Outpatient	123
Long Term Care	123
Mail Order	123
Military/VA	123
Oncology	123
Pain Management	123
Pediatrics	123
Pharmaceutical Research	123
Pharmaceutical Sales	123
Private Pharmacy	123
Psychiatric	123
Retail	123
Sub-Acute	123

PHARMACY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Pharmacy Experience	123
Admixture	123
Anticoagulant Dosing	123
Aseptic Technique	123
Blister Packs	123
Burns	123
Cardiothoracic/Cardiology	123
Cart Fill & Check	123
Chemotherapy	123
Chemotherapy Compound	123
Compound	123
Consulting	123
Critical Care	123
DME Equipment	123
Drug Information Specialist	123
Drug Interactions	123
Drug Rehabilitation Programs	123
Emergency Rooms	123
Enteral Feeding	123
Formulary Compliance	123
Emergency Pharmacy Experience	123
General Surgery	123
Geriatric	123
Hazardous Drug Handling	123
High Risk Pregnancies	123
Homeopathic Treatments	123
Immune Globulin Therapy	123
Infectious Disease	123
Infusion Pumps	123
Injections	123
Intensive Care Unit	123
IV Preparations	123
Inventory Ordering	123
Kinetic Dosing	123
Knowledge of OTC	123
Low Pressure Technique	123
Medical Nutrition Therapy	123
Multi-Disease Treatments	123
Narcotic Dispensing protocols	123
Neonatal	123
Nuclear Pharmacy	123
Nutritional Formulas	123
Nutrition Pharmacist	123
Nutritional Protocols	123
Oncology	123
Oral Suspension Reconstitution	123
Ostomy Supplies	123
PMB Prior Authorization Initiation/Follow-up	123
Pediatric Infusion Therapy	123
Pharmaceutical Calculations	123

SOFTWARE EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Pharmacy Software	123
Abbott	123
Access	123
BAXA	123
Baxter/Sure Med	123
Cerner	123
Etreby	123
HBS	123
Etreby	123
McKesson	123
Meditech	123
NDC	123
Opus-ISM	123
OSCO	123
PDX	123
Parata	123
Pharm ASSIST	123
PharmNet	123
Pharmtrak	123
Pyxis	123
Rx-Link	123
Tech Rx	123
Win Pharm	123

DOSING & CONVERSION:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Intravenous to oral	123
Intravenous to intravenous (for changes in brand)	123
Medication dosing for neonates/peds	123
Medication dosing for young adults/adult/geri/obese	123
Oral to intravenous	123
Oral to intravenous	123
Unit Dose: solids & oral liquids	123
Use of actual body weight for dosing	123
Use of ideal body weight for dosing	123

AGE-SPECIFIC COMPETENCIES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Infant (birth to 1 year)	123
Toddler (ages 1-3 years)	123
Preschooler (ages 3-5 years)	123
Childhood (ages 6-12 years)	123
Adolescents (ages 12-21 years)	123
Young Adults (ages 21-39 years)	123
Adults (ages 40-64 years)	123
Older Adults (ages 65-79 years)	123
Elderly (ages 80+ years)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *