WORK SETTINGS

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 Care123
Clinic123
Compounding123
Consulting123
Correctional Facility123
Geriatrics123
Home Health123
Home Infusion123
Hospital-in patient123
Hospital-Outpatient123
Long Term Care123
Mail Order123
Military/VA123
Oncology123
Pain Management123
Pediatrics123
Pharmaceutical Research123
Pharmaceutical Sales123
Private Pharmacy123
Psychiatric123
Retail123
Sub-Acute123
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 Experience123
Admixture123
Anticoagulant Dosing123
Aseptic Technique123
Blister Packs123
Burns123
Cardiothoracic/Cardiology123
Cart Fill & Check123
Chemotherapy123
Chemotherapy Compound123
Compound123
Consulting123
Critical Care123
DME Equipment123
Drug Information Specialist123
Drug Interactions123
Drug Rehabilitation Programs123
Emergency Rooms123
Enteral Feeding123
Formulary Compliance123
Emergency Pharmacy Experience123
General Surgery123
Geriatric123
Hazardous Drug Handling123
High Risk Pregnancies123
Homeopathic Treatments123
Immune Globulin Therapy123
Infectious Disease123
Infusion Pumps123
Injections123
Intensive Care Unit123
IV Preparations123
Inventory Ordering123
Kinetic Dosing123
Knowledge of OTC123
Low Pressure Technique123
Medical Nutrition Therapy123
Multi-Disease Treatments123
Narcotic Dispensing protocols123
Neonatal123
Nuclear Pharmacy123
Nutritional Formulas123
Nutrition Pharmacist123
Nutritional Protocols123
Oncology123
Oral Suspension Reconstitution123
Ostomy Supplies123
PMB Prior Authorization Initiation/Follow-up123
Pediatric Infusion Therapy123
Pharmaceutical Calculations123
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 Software123
Abbott123
Access123
BAXA123
Baxter/Sure Med123
Cerner123
Etreby123
HBS123
Etreby123
McKesson123
Meditech123
NDC123
Opus-ISM123
OSCO123
PDX123
Parata123
Pharm ASSIST123
PharmNet123
Pharmtrak123
Pyxis123
Rx-Link123
Tech Rx123
Win Pharm123
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 oral123
Intravenous to intravenous (for changes in brand)123
Medication dosing for neonates/peds123
Medication dosing for young adults/adult/geri/obese123
Oral to intravenous123
Oral to intravenous123
Unit Dose: solids & oral liquids123
Use of actual body weight for dosing123
Use of ideal body weight for dosing123
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 *