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Cardiac Echo

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Work Settings

Adult Acute Care *

ED/ICU *

Adult Outpatient *

Pediatric Acute Care *

Pediatric Outpatient *

Adult Echo

Routine *

3-D Echo *

Pedoff Probe *

Transesophageal Echo *

Stress Echo *

Pharmacologic Stress Echo *

Post-Cath Echo *

Post-Surgical Echo *

Imaging with Contrast Agents *

Sterilization Procedures *

Special Views

Pulmonary Veins *

Hepatic Veins *

Suprasternal Notch *

Calculations

Simpson's Rule *

Proximal Isovelocity Surface Area *

Distology with TDI *

LV Strain/LV Volume *

Pediatric Echo

Routine *

3-D Echo *

Pedoff Probe *

Transesophageal Echo *

Pediatric Anomalies

Aortic Arch Abnormalities/Vascular Ring *

Arch Sidedness *

Coarctation of the Aorta *

Coronary Artery Anomalies *

Double Outlet Ventricle *

Hypoplastic Heart Syndrome *

Pulmonary Venous Return Anomalies *

Tetralogy of Fallot *

Transposition of the Great Vessels *

Tricuspid and Pulmonary Atresia *

Truncus Arteriosis *

Univentricular Heart Anomalies *

Pediatric Post-Surgical Scans

Arterial Switch *

Blalock - Taussig *

Damus-Kaye-Stansel *

Fontan *

Glenn *

Konno *

Mustard *

Norwood *

Rastelli *

Sano *

Sennig *

Equipment

Phillips/ATL (List Types) *

GE (List Types) *

Siemens (List Types) *

Toshiba (List Types) *

Hitachi (List Types) *

SonoSite (List Types) *

Other: List *

Technology

McKesson *

Epic *

Horizon *

SCI- Imaging *

Online Reporting *

EMR Conversion *

Miscellaneous

12 Lead ECG *

Stress Testing *

Holter Monitor *

Professional Knowledge and Skills

National Patient Safety Goals *

Supervisory /Management Experience *

Isolation/Infection Prevention *

Procedures for Patients on Ventilators *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

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