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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
Your resource for traveling nurse and allied health career opportunities.
Copyright (C) 2013 Hudson Staffing. All rights reserved.