Ultrasound/Sonographer Technologist Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAbdominalAorta 1 2 3 4 Appendix/Intussusception 1 2 3 4 GI Tract 1 2 3 4 IVC (Inferior Vena Cava) 1 2 3 4 Liver/Biliary Tract 1 2 3 4 Pancreas/Spleen 1 2 3 4 Renal/Urinary System 1 2 3 4 Trans-Rectal 1 2 3 4 Vasculature 1 2 3 4 OB & Gynecology1st Trimester 1 2 3 4 2nd/3rd Trimester 1 2 3 4 High Risk OB 1 2 3 4 Placenta 1 2 3 4 Gestational Age 1 2 3 4 Complications 1 2 3 4 Amniotic Fluid/Amniocentesis 1 2 3 4 Fetal Demise 1 2 3 4 Fetal Abnormalities 1 2 3 4 Fetal Biophysical Profile 1 2 3 4 UGR Protocols 1 2 3 4 Coexisting Disorders 1 2 3 4 Follicular Study 1 2 3 4 Ovaries and Adnexa 1 2 3 4 Pediatric 1 2 3 4 Pelvic Pathology 1 2 3 4 Postmenopausal Pathology 1 2 3 4 Trans-Vaginal 1 2 3 4 Uterus and Adnexa 1 2 3 4 Nuchal Translucency 1 2 3 4 InterventionalAspiration 1 2 3 4 Biopsies 1 2 3 4 Drainage 1 2 3 4 Intraoperative 1 2 3 4 Laparoscopic 1 2 3 4 NeonatalCongenital Abnormality 1 2 3 4 Neonatal Head 1 2 3 4 NeurosonologyEnlargement/Displacement 1 2 3 4 Cranial Hemorrhage 1 2 3 4 Atrophic Lesions 1 2 3 4 Spinal Lesions 1 2 3 4 Inflammatory Lesions 1 2 3 4 Brain Swelling/Edema 1 2 3 4 Spinal Tethering 1 2 3 4 Trauma 1 2 3 4 Small PartsAbdominal Wall 1 2 3 4 Breast 1 2 3 4 Haematomas/Vessels 1 2 3 4 Musculoskeletal 1 2 3 4 Scrotum and Testes 1 2 3 4 Superficial Masses 1 2 3 4 Thyroid 1 2 3 4 Non-Cardiac/Chest 1 2 3 4 VascularColor Doppler 1 2 3 4 Digital Acquisition Systems 1 2 3 4 Diameter for Percentage of Stenosis 1 2 3 4 PW&OR CW for Percentage of Stenosis 1 2 3 4 TCD 1 2 3 4 PVR (Arms & Legs) 1 2 3 4 IPG (Arms & Legs) 1 2 3 4 Resistive Index 1 2 3 4 Pulsatility Index 1 2 3 4 Power Doppler 1 2 3 4 Segmental Pressures 1 2 3 4 Pulse Volume Recording 1 2 3 4 Abdominal Aorta, IVC 1 2 3 4 Abdominal Doppler 1 2 3 4 Carotid Doppler 1 2 3 4 SMA, Celiac, Renal 1 2 3 4 Hepatic, Splenic 1 2 3 4 Arterial Graft Duplex 1 2 3 4 Arterial Upper Extremities 1 2 3 4 Venous Upper Extremities 1 2 3 4 Arterial Lower Extremities 1 2 3 4 Venous Lower Extremities 1 2 3 4 Penile Doppler 1 2 3 4 Plethysmography for Fingers & Toes 1 2 3 4 Vein Mapping 1 2 3 4 EchoTransthoracic 1 2 3 4 Transesophageal (TEE) 1 2 3 4 Holter Monitoring 1 2 3 4 EKG 1 2 3 4 Bubble Studies 1 2 3 4 Adult 1 2 3 4 Neonatal 1 2 3 4 Pediatric 1 2 3 4 2-D and M Mode 1 2 3 4 Exercise Pharmacological (Dobutamine) 1 2 3 4 Pulsed Doppler 1 2 3 4 Color Doppler 1 2 3 4 Treadmill Exercise Testing 1 2 3 4 ECG 1 2 3 4 Stress 1 2 3 4 Experience in Primary AreasHospitals 1 2 3 4 Clinics 1 2 3 4 Physician Office 1 2 3 4 Mobile 1 2 3 4 Supervisory Experience 1 2 3 4 EMRAllScripts 1 2 3 4 ARIA 1 2 3 4 Athena 1 2 3 4 Canopy 1 2 3 4 Cerner 1 2 3 4 Eclipsys 1 2 3 4 Epic 1 2 3 4 McKesson 1 2 3 4 Meditech 1 2 3 4 Other Computerized System 1 2 3 4 Computerized Physician Order Entry 1 2 3 4 Bar Coding for Medication Administration 1 2 3 4 Age Specific Practice CriteriaNewborn/Neonate (birth - 30 days) 1 2 3 4 Infant (30 days - 1 year) 1 2 3 4 Toddler (1 - 3 years) 1 2 3 4 Preschooler (3 - 5 years) 1 2 3 4 School age children (5 - 12 years) 1 2 3 4 Adolescents (12 - 18 years) 1 2 3 4 Young adults (18 - 39 years) 1 2 3 4 Middle adults (39 - 64 years) 1 2 3 4 Older adults (64+ years) 1 2 3 4 ExpertisePlease list any areas of expertise belowAuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Ultrasound/Sonographer Technologist Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
