Breadcrumb Home Therapist Checklists PT/PTA Skills 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 Adult Neck Injuries / Surgeries * Back Injuries / Surgeries * Hip Fractures / Injuries * Total Hip Replacement * Knee Injuries * Total Knee Replacement * Upper Extrem Joint Replacements * Shoulder Injuries * Degen. Joint Disease / Arthritis * Hand Injuries * Temporomandibular Joint (TMJ) * Post Operative Care * Amputations * Stroke Rehabilitation * Cognitive Disorders * Head Trauma * Spinal Cord Injury * Functional Splinting * Adaptive Equipment-Wheelchair * Neuromuscular Diseases * Multiple Sclerosis * Upper Extremity Prosthetics * Above Knee Prosthetics * Below Knee Prosthetics * Sports Medicine LIDO * Nautilus / Eagle * Taping * Other * Chest PT * Cardiac Rehab * ICU Procedures * CCU Procedures * SICU Procedures * Burn Management * Work Hardening - Work Site Eval * Work Capacity Eval * Procedures / Treatments Ankle / Foot Orthosis * Slings * Splints - Wrist / Hand * CPM Machine * Hydrotherapy * Whirlpool * Hubbard Tank * Therapeutic Pool * TENS * Electrical Stimulation * Ultrasound * Cryotherapy * Massage * Diathermy * Acupressure * Spinal Mobilization * Extremity Mobilization * Myofacial Release * Craniosacral Techniques * Cervical Traction * Lumbar Traction * Activities of Daily Living * Gait Training * Transfers * Sports Medicine * Athletic Injuries * Biodex * Cybex * Orthotron * Other Functional Capacity Eval * Muscle Energy Techniques * Universal Precautions * Skilled Nursing Documentation - Medicare A * Skilled Nursing Documentation - Medicare B * Skilled Nursing Documentation - State Healthcare * Age Specific Competencies Newborn (birth-30 days) * Infant (30 days - 1 year) * Toddler (1 - 3 years) * Preschooler (3 - 5 years) * School Age (5 - 12 years) * Adolescents (12 - 18 years) * Young Adults (18 - 39 years) * Middle Adults (39 - 64 years) * Older Adults (64+ years) *