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Surgical Technologist

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

Skill Level

AKA/BKA (amputation) *

Abdominal-Perineal Resection *

Cholecystectomy (Open) *

Exploratory Laparotomy *

Appendectomy *

Laparoscopic Procedure

Cholecystectomy *

Appendectomy *

Hernia *

Nissan *

Colectomy *

Gastrectomy *

Inguinal / Ventral Hernia Repair *

Spienectomy *

Bowel Resection / Colostomy *

Thyroidectomy *

Rectal Procedures *

Esophagascopy / Gastroscopy *

Pediatric Case

Inguinal Hernia Repair *

Pyloric Stenosis *

Circumcision *

Exploratory Laparotomy *

E.N.T

Middle Ear Cases *

T&A *

Myringotomy *

Tympanoplasty *

Radical Neck Dissection *

Septoplasty *

Sinus Endoscopy *

Cardiac / Thoracic / Vascular

Coronary Artery By-pass *

Mitral Valve Repair / Replacement *

Aortic Valve Replacement *

Multiple Valve Transposition *

Septal Defects *

Ventricular Aneurysm Repair *

Bring Back Heart *

Pericardial Window *

Intra-Aortic Balloon Insertion *

Heartport or Similar CABG *

Thoraco Approach Mid-Cab *

Aortic Arch Replacement *

Aortic Valve Conduit *

Mechanical Heart / LVAD *

Pediatric Hearts *

Tetrology of Fallot *

Chamberlin Procedure *

AICD Insertion *

Saphenous Vein Harvest *

Endoscopic Vein Harvest *

Gastric Artery Harvest *

Radial Vein Harvest *

Insertion Vena Cava Filter *

Thoracotomy *

Thoracoscopy *

Insertion Chest Tube *

Esophageal Repair *

Pneurnonectomy / Lobectomy *

Mediastinodcopy *

Desendind Aortic Repair *

Arterial Stenting *

Intra-Operative Angioplasty *

Vascular Surgery

Carotid Endarterectomy *

Abdominal Aortic Aneurysm *

Femoral

Popliteal By-pass Graft (Insitu) *

Popliteal By-pass Graft (Graph) *

Portacath, Tesio, Hickman Placement *

AV Shunt *

Thrombectomy *

Pacemaker Insertion *

Arterial Stenting *

Intra-Operative Angioplasty *

Subclavin / Carotid By-pass *

Orthopedics

Total Hip Replacement *

Bipolar Hip *

Compression Hip Screw *

Total Knee Replacement *

Knee Arthroscopy *

ACL Knee Repair *

Harrington Rod or Similar *

I.M. Rodding *

Hand Procedures *

Foot Procedures *

Mini, Standard, Large Fragment

Screws & Plates *

External Fixation *

Shoulder Repair *

Shoulder Arthroscopy *

Spinal Fusion *

Cast Application *

Fracture Table Set-up *

Drills, Saws and Reamers *

Urology

Radical Prostatectomy *

Radical Lymph Node Dissection *

Ureteroscopy *

TURP / TURST *

Ultrasonic Lithotripsy *

Hydrocelectomy *

Cystoscopy *

Insertion Penile Prosthesis *

Gynecology

D & C *

Diagnostic Laparascope *

Laparoscopic Vaginal Hysterectomy *

Abdominal Hysterectomy *

Vaginal Hysterectomy *

Anterior Repair *

Posterior Repair *

MMK (Marshall Marchetti Krantz) *

Tuboplasty *

BTL (Bilateral Tubal Ligation) *

C-Sections *

Neurology

Cervical Laminectomy (Anterior) *

Cervical Laminectomy (Posterior) *

Lumbar Laminectomy Discectomy *

Percutaneous Micro Discectomy *

Craniotomy For Tumor *

Craniotomy For Aneurysm *

Burr Holes *

VP Shunts *

Transphenoidal Hypothypectomy *

Carpal Tunnel Repair *

Harrington Rod or Similar *

Trauma Surgery

Transplant Surgery *

Organ Procurement (Harvest) *

Plastics

Mammoplasty *

Facelifts *

Skin Grafts *

Rhinoplasty *

Cleft Lip Repair *

Abdominalplasty *

Blepharoplasty *

Otoplasty *

Muscle Flaps *

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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