Breadcrumb Home Therapist Checklists Physical Therapist Self Assessment Form Information Info Name * Last 4 digits of SSN * Contact Phone * Email * Proficiency Scale 1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently Work Settings Adult/Adult ICU * Children's Hospital * General Acute Care * Home Health Care * Outpatient Neuro * Outpatient Ortho * Pediatrics/PICU * Psychiatric Hospital * Rehabilitation Hospital * School Setting * Early Intervention * Skilled Care Facility * Subacute * Orthopedics Upper Extremities * Arthritis Programs * Back Syndrome * Cervical Injuries * Chronic Fatigue Syndrome * Fibromyalgia * Halo Traction * Hand Injury * Hip Fracture * Kyphoplasty * Orthopedics - cont. Manual Therapy * Mobilization Techniques * Pelvic Fracture * Postpolio Syndrome * Shoulder Injuries * TMJ Dysfunction * Total Hip/Total Knee * Total Joint Replacement * Total Shoulder/CPM * Neurologic ALS * Brain Tumors * Cerebral Palsy * Multiple Sclerosis * Muscular Dystrophy * Polio/Post Polio Syndrome * Spinal Cord Injury * Adaptive Equipment * Functional Splinting * Neurodevelopmental Testing (NDT) * Head Trauma * Glasgow Coma Scale * Stroke Rehabilitation * Wheelchair Prescription * Pediatrics Activities of Daily Living * Adaptive * Developmental Disability * Equipment Assessment * Individualized Education Programs * Neurodevelopmental Testing (NDT) * Orthotics * Sequencing Testing * Sports Medicine Biodex * Bracing/Joint * Cybex * Immobilization * Lido * Medical Expenses (Norwegian) * Nautilus/Eagle * Orthotron/Kinetron * Stabilization Techniques * Swiss Ball * Taping/Strapping * Prosthetics/Orthotics Dynamic Splints * LE Prosthetics * Protonics * Removable Rigid Dressings * Serial Casting * Static Splints * UE Prosthetics * Modalities Anodyne * Biofeedback * Edema Massage * Fluidotherapy * Iontophoresis * JOBST Compression Pump * Muscle Stimulation * Paraffin Bath * Phonophoresis * TENS * Therapeutic Pool * Ultrasound * Other Burn Management * Cardiac Rehabilitation * Chest Physical Therapy * DME Ordering * FIM Scoring * Job Task Analysis * Lymphedema Management * OASIS Assessment for Home Care * Obstetrics in Physical Therapy * Tone Management/Spasticity * Wheelchair Ordering for SCI Patients * Work Capacity Evaluation * Work Hardening * Wound Care * Medicare * Medicaid * MDS * General Skills Patient/Family Teaching * Patients in Isolation * Patients in Restraints * Initial Evaluation * Lift/Transfer Devices * Specialty Beds * End of Life Care/Palliative Care * Cerner * EPIC * McKesson * Meditech * Accurate Patient Identification * Effective communication * General Skills - cont. Pain Assessment & Management * Infection Control * Universal Precautions * Care of Patients in Isolation * Minimize Risk of Falls * Prevention of Pressure Ulcers * 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) *