Hudson Staffing Travel Nurses & Allied Health Careers
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Hudson Staffing Travel Nurses| COTA Online Checklist
COTA Online Checklist

Thank you for your decision to apply for a travel nursing position with Hudson Staffing! Before we can offer you a nursing employment opportunity in the COTA field, an electronic skills assessment must be completed. Please, complete the nursing skills checklist below, and be sure to review your information thoroughly before clicking the submit button.

GENERAL INFORMATION        
Note: * Denotes a required field.
Please enter your full name as it appears on your Social Security Card:

First Name
 
Middle Name
 
Last Name
 *


Please enter the Last Four digits of your Social Security Number:

 -   -   *       Please check here if you do not hold a valid social security card.


Please provide your contact information:

Phone Number
 *
E-mail Address
 *
Confirm E-mail Address
 *
Type your e-mail address again above.
       
This profile is for use by healthcare professionals in the COTA discipline and specialty.
It will not be a determining factor for the program.
CHECKLIST INSTRUCTIONS        
Please mark your level of experience

     1. No theory and/or experience
     2. Limited experience/need supervision and/or support
     3. Experienced/minimal support needed to perform
     4. Proficient/can perform independently

Orthopedics 1 2 3 4
     Total Hip Replacements
     Total Knee Replacements
     UE Joint Replacements
     Amputation
     Fractures/Dislocations
     Trauma Hand Injury
     Arthritis
     Back Injury
     Multi-trauma
General Acute Care 1 2 3 4
     !Discharge Planning
     Home Assessment
     Home Modification/Adaptation
     Driver Re-education
!Neurological
     Traumatic Brain Injury
     CVA/Stroke
     Spinal Cord Injury
     Coma Management
     Peripheral Nerve Injury
     Reflex Sympathetic Dystrophy
     Parkinson's
     Multiple Sclerosis
     Alzheimer's
     Cumulative Trauma Disorders
     Gullian Barre Syndrome
     ALS
     Laminectomy
     Crainiotomy
!Pediatrics
     NICU
     Congenital Anomalies
     Cerebral Palsy
     Spina Bifida
     Musculoskeletal Disorders
     Juvenile Rheumatoid Arthritis
     Arthrogryposis
     Genetic Conditions
     Learning Disabilities
     Peravise Developmental Disorders
     AIDS
     General Medical Conditions
     Sensory Integration
!Orthotics/Prosthetics
     Static Splinting
     Dynamic Splinting
     Serial Inhibitory Casting
     UE Prosthetics Assess/Train
     LE Prosthetics Assess/Train
Hand Therapy        
     Y/N Modality Certification Yes No
     Y/N Certified Hand Therapist Yes No
Techniques 1 2 3 4
!Assessments
     Independent Living Skills/Life Management Skills
     Physical
     Psychosocial
     ADL
     Cognitive/Perceptual
     Sensory
     Therapeutic Adaptation
     Positioning
     Restraint Reduction
     Home Safety
     Modalities
!Treatment
     Neurodevelopmental
     Transfer Training
     ADL Retraining
     Home Management
     Post-op Client
     Education/Precautions
     Positioning
     Tone Management
     Postural Re-education
     Multi Trauma
     Work Simplification/Energy Conservation
     Sensory Re-education
     Sensory Integration
     Manual Therapy
     Functional Mobility/Retraining
     Prosthetic Training
     Valpar
     BTE
     Assistive Technology
     Psychosocial Integration
     Reflex Management
Documentation 1 2 3 4
     Mental Health
     Medicare Documentation
     700 & 701 Forms
     PPS
     MDS Form
Primary Experience 1 2 3 4
     General Acute Care
     Rehabilitation
     Skilled Nursing Facility
     Home Health Care
     Outpatient Services
     Industrial Medical Clinic
     Hand Clinic
     CHT-Certified Hand Therapist
     Children's Hospital
     School Systems
     Psychiatric Hospital
Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox.

* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this COTA Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.




Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (44.192.65.228) which will be used as a digital signature.



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Hudson Staffing
Phone: 1(866)256-8773
E-mail: info@hudsonstaffing.net

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