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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

PROCEDURES EXPERIENCE *
Assist with EGD’s123
Assist with endoscopic ultrasound123
Assist with active GI bleed123
Cautery devices123
Assist with manometry studies123
Assist with variceal banding123
Assist with esophageal dilatations123
Assist with esophageal ballooning123
Assist with scelrotherapy123
Assist with TEE123
Assist with bronchoscopy123
Assist with colonoscopy123
Assist with polypectomy123
Assist with ERCP’s123
Assist with PEG placements123
Assist with liver BX123
Assist with collection of hot & cold BX’s123
Specimen collection & labeling123
Set up of scopes & video equipment123
Apply external abdominal pressure to assist with scope movement123
Scope cleaning123
Assist with mobile cases, ICU, ER, etc.123
Radiation safety123
Automated Medication Dispensing System, Pyxis, Omnicell, or other123
Takes call for emergency cases123
National Patient Safety Goals123
Awareness of HCAHPS123
Accurate patient identification123
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Labeling (medications & specimens)123
Anticoagulation therapy123
Monitoring conscious sedation123
Pain assessment & management123
Infection control123
Universal precautions123
Isolation123
Minimize risk for falls123
Prevention of pressure ulcers123
Use of rapid response teams123
ADMINISTER CONSCIOUS SEDATION *
Fentanyl123
Propofol123
Demerol123
Presedex123
Versed123
Reversal agents123
PRE PROCEDURE *
Pre procedure phone calls123
Electronic documentation123
Patient assessment123
Colon prep or re-prep123
Pre procedure checklist / consent123
IV start, med admin123
POST PROCEDURE *
Assess for air movement post colonoscopy123
Assess for pain123
Assess for bowel sounds123
Assess for gag reflex post EGD123
Assess for gag reflex post bronchoscopy123
Recover from MAC123
Recover from (moderate) conscious sedation123
Discharge outpatients to home123
Post procedure phone calls123
AGE SPECIFIC COMPETENCIES EXPERIENCE *
Newborn / neonate (birth-30 days)123
Infant (31 days-1 year)123
Toddler (ages 2-3 years)123
Preschool (ages 4-5 years)123
School age (ages 6-12 years)123
Adolescent (ages 13-21 years)123
Young adult (ages 22-39 years)123
Adult (ages 40-64 years)123
Older adult (ages 65-79 years)123
Elderly (ages 80+ years)123
ATTESTATION *