NUCLEAR MED TECH KNOWLEDGE & SKILLS

CHECKLIST_______
NAME:       34. Technicare 560 Computer
ID #:      
DATE:       DIRECTIONS: Please indicate your level of experience by
placing a check (√) in the box. Experience level:
1 NO EXPERIENCE
This Skills Checklist is for use by nurses with more than 2 MINIMAL EXPERIENCE-requires supervision/assistance
one year experience in their discipline and specialty.
Please be accurate with your assessment. 3 MODERATELY EXPERIENCED-requires initial review,
then performs independently
DESCRIPTION 1 2 3 4 4 VERY EXPERIENCED- proficient
EQUIPMENT
1. 3D Reconstruction Packet DESCRIPTION 1 2 3 4
2. ADAC Camera 35. Technicare Omega 500 Camera
3. ADAC Computer 36. Technicare Port 420
4. Centiview 37. Technicare Port 550
5. Digital Computer 38. Toshiba 6000
6. Elscint Camera 39. ZLC
7. GE LFOV 40. Picker Prism
8. GE MAZI 400 Camera PROCEDURES
9. GE Star Cam Spect 1. I-123 Uptake
10. GE Star 1 Computer 2. I- 131 Therapy
11. GE Star Cam Computer 3. Aerosol Lung Scan
12. Genesis 4. Bone Scan
13. Genesis Computer 5. Brachytherapy
14. Hepatic Hemangloma 6. Brain Scan
15. Hitachi 7. Cerebral Blood Flow
16. MDS Camera Medispect 8. Gallium Scan
17. MDS Medispect 9. GI Bleeding Study
18. Micro Dot Computer 10. HIDA Scan
19. Ohio Nuclear 11. Hot Lab
20. Ohio Nuclear 410 Camera 12. Indium – 111 WBC
21. Omega 500 13. Liver Scan
22. Omega 500 Computer 14. MUGA Scan
23. Phillips (NM) 15. NVG Rest
24. PhoGamma IV 16. NVG Stress
25. Picker (NM) 17. Persantine Thallium
26. Siemens Computer 18. Radionuclide Arteriogram
27. Siemens Diacam 19. Radionuclide Venogram
28. Siemens Orbiter Camera 20. Renagrams
29. Siemens Spect 21. Renal Scan
30. Sophy Camera D57 22. RIA (Radio Immuno Assay)
31. Sophy Computer 23. Shillings
32. Summit 24. SPECT
33. Technicare 438 Camera 25. Spleen Scan
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 NUCLEAR MED TECH KNOWLEDGE & SKILLS
CHECKLIST_______
26. Stress Holter Monitoring
27. Tescticular Studies

Name:      

ID #:      
DESCRIPTION 1 2 3 4
PROCEDURES (CONT)
28. Thallium Stress Test
29. Three Phase Renal Scan
30. Thyroid Therapy
31. Thyroid Scan
32. Thyroid Uptake
33. VP Lung Scan
34. PET Scanning
35. Radio Pharmaceutical Prep
36. Other
COMPUTERIZED CHARTING
1. Cerner
2. Eclipsys
3. Epic
4. McKesson
5. Meditech
6. Other:
BACKGROUND & EXPERIENCE Months/
Years
1. Applications
2. Clinic
3. Doctor’s Office
4. Hospital
5. Management
6. Mobile Route
7. Nuclear Cardiology
8. Teaching Equipment
9. Other:
POSITIONS HELD Months/
Years
1. Registered Nuc Med Tech, NMTCB
2. Registry – Eligible Nuc Med Tech
3. NM Supervisor
4. NM Director
5. Nuclear Cardiology Tech
6. Registered Nuc Med Tech, AART
7. Other:

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 NUCLEAR MED TECH KNOWLEDGE & SKILLS
CHECKLIST_______

Name:       MY EXPERIENCE IS PRIMARILY IN:

Please check the boxes below for each age group for NEUROLOGY       years
which you have expertise in providing age-appropriate PULMONARY       years
nursing care. SURGICAL       years
MEDICAL       years
A. Newborn/Neonatal (birth – 30 days) CARDIAC CARE       years
B. Infant (30 days – 1 year) TELEMETRY       years
C. Toddler (1 – 3 years)
D. Preschool (3 – 5 years) I HAVE CURRENT CERTIFICATIONS FOR:
E. School Age Children (5 – 12 years)
F. Adolescent (12 – 18 years) TYPE COURSE DATE (MM/DD/YY)
G. Young Adults (18 – 39 years) ACLS      
H. Middle Adults (40 – 64 years) BLS      
I. Older Adults (64 + years) Other            
Other            
EXPERIENCE WITH AGE GROUPS: Other            
1. Able to assess age appropriate behavior, motor skills Other            
and physiological norms.
The information I have provided in this knowledge and
A B C D E F G H I skills checklist it true and accurate to the best of my
knowledge.

2. Able to adapt care according to normal growth and            

development. Signature (Written/Electronic) Date
ID #:      
A B C D E F G H I
This skills checklist has been reviewed and approved by
Nicole Bloxham, RN.
3. Able to communicate and instruct patient according to
their age, maturity and comprehension ability.            
Signature (Written/Electronic) Date
A B C D E F G H I ID #:      

4. Able to provide a safe environment according to the

specific needs of various age groups. Please return to: Northwest Nurse Staffing Company, PA
ATTN: Records Dept.
Fax: (866) 352-4338
A B C D E F G H I
Email: records@nns-ic.com

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