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Pharmacist

Pharmacist

  • MM slash DD slash YYYY

  • Self-Assessment Rating Scale:

    No Experience
    Theory or observation only during the past 12 months

    Limited Experience
    Performed less than 12 times within the past 12 months and may need a review

    Experienced
    Performed at least once per month within the past 12 months and may need minimal assistance

    Highly Skilled
    Performed on at least a weekly basis over the past 12 months; proficient
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Hospital
    Retail
    Home Infusion
    Long Term Care Facility
    Nuclear Dispensing
    Formulary Management
    Patient Education
    Third Party Programs
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Pediatrics
    Geriatrics
    Oncology
    Nuclear
    Nutrition
    Infectious Disease
    Kinetics
    Pain Management
    Psychiatric Patient Management
    Renal Patient Management
    Diabetic Patient Management
    Young’s Rule
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Antibiotics
    Chemotherapy
    TPN
    Piggybacks
    Kinetics
    Isotonic Solutions
    Epidural/PCA Pump Management
    Code Blue (CPR) Management
    Nuclear Pharmacy
    Electrolyte Solutions
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Diabetes
    Asthma
    Anticoagulation
    AIDS/HIV patients
    Anesthesia Management
    Chemotherapeutics/Oncology
    Endocrinology
    Crowling’s rule
    Freid’s Rule for Infants
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Dose Calculations
    Calibration of Droppers
    Drug Dose based on Age
    Drug Dose based on Body Weight
    Drug Dose based on Body Surface Area
    Altering Formulas
    Mass/Volume/Density
    Specific Gravity for Liquids
    Specific Gravity for Solids
    Specific Volumes
    Percentage Calculations
    % Weight in Volume
    % Volume in Volume
    % Weight in Weight
    Conversions of Concentrations to mg/ml
    Dilution and Concentration
    Alcohol Dilution
    Acid Dilution
    Stock Solutions
    Isotonic and Electrolyte Solutions
    Calculations for Isotonic Solution Preparation
    Millimoles vs. Milligram
    Osmolarity
    Constituted Solutions and Admixtures
    Oral Solution/Suspension
    Parenteral
    Drug Availability and Pharmacokinetics
    Elimination Rate and Elimination Half Life
    Creatinine Clearance Rate
    Adjusting Creatinine Clearance Rate
    Radioactive Pharmaceuticals
    Intersystem Conversions
    Solubility Ratios
    Buffer Solutions
    Prescription Pricing
    Other (list):
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Baxter
    Abbott
    McKesson Home
    Pyxsis Rx
    Meditech
    Other:

  • By signing below, I attest that the information contained above is accurate to the best of my knowledge, and that I am the individual completing this form. I further authorize the Company to release this Qualification List to the Client facilities in accordance with the consideration of employment as a Healthcare Professional with those facilities.
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